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Focal Nodular Hyperplasia Inducing Hepatic Vein Obstruction

Anne-Sophie Rangheard1, Valérie Vilgrain1, Pascale Audet1, Dermot O'Toole2, Marie-Pierre Vullierme1, Dominique Valla3, Jacques Belghiti4 and Yves Menu1

1 Department of Radiology, Hospital Beaujon, 100 ave. du Général Leclerc, 92110 Clichy, France.
2 Department of Gastro-Enterology, Hospital Beaujon, 92110 Clichy, France.
3 Department of Hepatology, Hospital Beaujon, 92110 Clichy, France.
4 Department of Visceral Surgery, Hospital Beaujon, 92110 Clichy, France.



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  		Fig. 1A. —39-year-old woman with 12-cm focal nodular hyperplasia in right liver (segments VI and VII). T2-weighted MR image shows voluminous mass (arrow) in right liver.

 


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  		Fig. 1B. —39-year-old woman with 12-cm focal nodular hyperplasia in right liver (segments VI and VII). Coronal time-of-flight MR angiogram shows subcapsular collateral pathway (arrows) between middle and right hepatic veins.

 


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  		Fig. 2A. —40-year-old woman with 10-cm focal nodular hyperplasia in liver segment I. Arterial phase contrast-enhanced CT scan shows strongly enhancing mass in segment I with central scar (arrowhead).

 


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  		Fig. 2B. —40-year-old woman with 10-cm focal nodular hyperplasia in liver segment I. Portal phase contrast-enhanced CT scan at same level as A shows obstruction of middle hepatic vein, associated with intrahepatic (arrow) and subcapsular (arrowhead) venous pathway between middle and right hepatic veins.

 


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  		Fig. 2C. —40-year-old woman with 10-cm focal nodular hyperplasia in liver segment I. T2-weighted MR image shows isointense mass with central hyperintensity corresponding to central scar (arrowhead). Inferior vena cava is compressed by mass (arrow).

 


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  		Fig. 2D. —40-year-old woman with 10-cm focal nodular hyperplasia in liver segment I. Portal phase gadolinium-enhanced T1-weighted MR image shows enhancement of venous collateral pathway (arrowheads).

 


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  		Fig. 3A. —42-year-old woman with 4-cm focal nodular hyperplasia located centrally in liver. Sonogram reveals isoechoic mass (arrowhead) in segments II, IV, and VIII that obstructs middle hepatic vein (arrow).

 


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  		Fig. 3B. —42-year-old woman with 4-cm focal nodular hyperplasia located centrally in liver. Sonogram obtained at level below A shows intrahepatic venous collateral pathway (single solid arrow) between middle (double solid arrows) and right (open arrow) hepatic veins.

 


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  		Fig. 3C. —42-year-old woman with 4-cm focal nodular hyperplasia located centrally in liver. Sonogram obtained in more cranial section than B clearly shows distal segment of intrahepatic venous collateral pathway (solid arrow). Pathway drains into right hepatic vein (open arrow).

 


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  		Fig. 3D. —42-year-old woman with 4-cm focal nodular hyperplasia located centrally in liver. Contrast-enhanced CT scan shows intrahepatic venous pathway (arrow).

 


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  		Fig. 3E. —42-year-old woman with 4-cm focal nodular hyperplasia located centrally in liver. T2-weighted MR image shows slightly hyperintense lesion in central liver that obstructs middle hepatic vein (curved arrow). Note calcified central scar (straight arrow).

 


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  		Fig. 3F. —42-year-old woman with 4-cm focal nodular hyperplasia located centrally in liver. T2-weighted MR image caudal to D shows intrahepatic collateral pathway between middle and right hepatic veins (arrow).

 

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