PMC4386441_01
Ultrasound of the liver showing a well-defined rounded hypoechoic mass involving the left lobe of the liver with a central stellate echogenic scar (A). The lesion shows internal vascularity (B) and there is an enlarged lymph node at the porta, with dilatation of intrahepatic biliary radicals with blocked confluence of the right and left hepatic ducts (C).
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Ultrasound of the abdomen was advised which showed a well-defined rounded hypoechoic mass involving the left lobe of the liver with a central stellate echogenic scar (Figure 1A). The lesion showed evidence of internal vascularity on Color Doppler (Figure 1B). There was evidence of another small rounded hypoechoic lesion at the porta with dilatation of intrahepatic biliary radicals with blocked confluence of the right and left hepatic ducts (Figure 1C).
Non-contrast CT of liver axial section showing a well-defined isodense mass in the left lobe of the liver with no calcification and with central stellate hypodensity due to the scar.
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Plain and triple-phase contrast-enhanced computed tomography of the abdomen was advised which showed a well-defined isodense mass in the left lobe of the liver with no calcification and with central stellate hypodensity (Figure 2), showing enhancement in the arterial phase (Figure 3A, 3B).
(A, B) Contrast-enhanced CT arterial phase axial sections showing enhancement of the left lobe mass (with non-enhancing central scar) as well as lymph node at the porta (B).
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Plain and triple-phase contrast-enhanced computed tomography of the abdomen was advised which showed a well-defined isodense mass in the left lobe of the liver with no calcification and with central stellate hypodensity (Figure 2), showing enhancement in the arterial phase (Figure 3A, 3B).
Contrast-enhanced CT venous phase axial (A) and coronal reconstructed image (B) showing a mass with enhancement similar to the surrounding liver (A, B) and gross hepatomegaly (B).
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The tumor was isodense to liver in the portal venous phase with a central non-enhancing stellate scar (Figure 4A, 4B).
Contrast-enhanced CT equilibrium phase showing partial wash-out of contrast from the mass with a part of the scar showing some enhancement.
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There was evidence of a partial washout in the equilibrium phase with a part of the scar showing enhancement (Figure 5).
Axial T2-weighted MR image showing an isointense mass with a central hypointense scar in the left lobe of the liver.
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T2-weighted Magnetic Resonance Imaging of the abdomen was performed (to search for signal intensity of the scar), which showed an isointense lesion with a central hypointense stellate scar (Figure 6). The diagnosis of fibrolamellar hepatocellular carcinoma was made based on pathognomonic features on imaging.