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Benign Hepatic Nodules in Budd-Chiari Syndrome

Radiologic—Pathologic Correlation with Emphasis on the Central Scar

¹ Department of Radiology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Japan, 606-8507.
² Department of Radiology, Kyoto University Hospital, Kyoto, Japan, 606-8507.
³ Department of Transplantation Immunology and Transplant Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan, 606-8507.
⁴ Organ Transplantation Unit, Kyoto University Hospital, Kyoto, Japan, 606-8507.
⁵ Laboratory of Pathology, Kyoto Katsura Hospital, 17 Yamada Hirao-cho, Nishikyo-ku, Kyoto, Japan.
⁶ Department of Medicine and Clinical Science, Kyoto University Hospital, Kyoto, Japan, 606-8507.

View larger version (126K): [in a new window]   Fig. 1. —26-year-old man with Budd-Chiari syndrome. Photograph of pathologic specimen shows benign hepatic nodule, 15 mm in diameter, with large central scar. Structure grossly and microscopically resembles focal nodular hyperplasia. (Masson's trichrome stain, x 4)

View larger version (168K): [in a new window]   Fig. 2D. —11-year-old boy with benign hepatic nodules associated with Budd-Chiari syndrome. Photograph of pathologic specimen shows 11-mm-diameter lesion with central scar. Congestion of liver parenchyma is scarce within nodule. (H and E, x4)

View larger version (162K): [in a new window]   Fig. 2A. —11-year-old boy with benign hepatic nodules associated with Budd-Chiari syndrome. Transverse unenhanced CT scan shows lesion is hyperattenuating compared with surrounding liver parenchyma (arrow). Central portion of nodule reveals hypodensity relative to its periphery.

View larger version (148K): [in a new window]   Fig. 2B. —11-year-old boy with benign hepatic nodules associated with Budd-Chiari syndrome. Transverse T2-weighted fast spin-echo MR image (TR/TE, 5454/80; flip angle, 90°) displays hypointense lesion with central hyperintense area (arrow).

View larger version (139K): [in a new window]   Fig. 3A. —31-year-old man with benign hepatic nodules associated with Budd-Chiari syndrome. Transverse fat-saturated T2-weighted fast spin-echo MR image (TR/TE, 5000/103; flip angle, 90°) shows hypointense lesion compared with surrounding liver parenchyma has internal small hyperintense spot (arrow).

View larger version (155K): [in a new window]   Fig. 2C. —11-year-old boy with benign hepatic nodules associated with Budd-Chiari syndrome. Transverse T1-weighted spin-echo MR image (500/9; flip angle, 90°) shows hyperintense nodule with central hypointense area (arrow).

View larger version (131K): [in a new window]   Fig. 3B. —31-year-old man with benign hepatic nodules associated with Budd-Chiari syndrome. Transverse fat-saturated T1-weighted spoiled gradientecho MR image (180/1.5; flip angle, 60°) shows hyperintense lesion with internal hypointense spot (arrow).

View larger version (158K): [in a new window]   Fig. 4A. —53-year-old man with benign hepatic nodules associated with Budd-Chiari syndrome. Anteroposterior hepatic arteriogram shows several small hypervascular lesions.

View larger version (147K): [in a new window]   Fig. 4C. —53-year-old man with benign hepatic nodules associated with Budd-Chiari syndrome. Image obtained on CT during hepatic arteriography at level identical with B shows several small hypervascular nodules (arrowheads). These nodules are located at poorly enhanced areas on CT during arterial portography.

View larger version (176K): [in a new window]   Fig. 3D. —31-year-old man with benign hepatic nodules associated with Budd-Chiari syndrome. Selective right hepatic arteriogram obtained at outside hospital shows centrifugal blood supply mimicking focal nodular hyperplasia (arrow). (Courtesy of Toru Hashimoto, Suita Municipal Hospital, Osaka, Japan)

View larger version (154K): [in a new window]   Fig. 4B. —53-year-old man with benign hepatic nodules associated with Budd-Chiari syndrome. Image obtained at four distinct levels on CT during arterial portography displays heterogeneous enhancement of liver parenchyma with multiple focal areas of decreased enhancement.

View larger version (119K): [in a new window]   Fig. 3C. —31-year-old man with benign hepatic nodules associated with Budd-Chiari syndrome. Transverse contrast-enhanced T1-weighted spoiled gradient-echo MR image (180/1.5; flip angle, 60°) obtained 180 sec after initiation of contrast agent administration shows internal spot (arrow) with delayed enhancement.

View larger version (174K): [in a new window]   Fig. 3E. —31-year-old man with benign hepatic nodules associated with Budd-Chiari syndrome. Photograph of macroscopic section of nodule reveals central scar (arrow) corresponding with that shown on MR images.

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