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Radiological Reasoning: Imaging Differentiation of a Solitary Hepatic Mass

¹ Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, White 270, 55 Fruit St., Boston, MA 02114.
² Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan.
³ Department of Radiology, Azienda Ospedaliera di Benevento G. Rummo, Beltiglio, BN, Italy.

View larger version (178K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —45-year-old woman with hepatic mass who presents with intermittent high fever. Abdominal sonogram reveals mildly lobulated, inhomogeneous hypoechoic lesion (arrow) in left lobe of liver.

View larger version (105K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —45-year-old woman with hepatic mass who presents with intermittent high fever. Axial contrast-enhanced CT scan of upper abdomen during portal venous phase shows mildly hyperdense to isodense mass with low-density rim (arrows) in left lobe of liver. Also note hypodense mass in spleen (arrowhead).

View larger version (104K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —45-year-old woman with hepatic mass who presents with intermittent high fever. Axial T1-weighted image of liver shows lesion (black arrows) in left lobe with hypointensity in central portion and more pronounced hypointensity in peripheral rim (white arrows), compared with normal liver parenchyma.

View larger version (96K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —45-year-old woman with hepatic mass who presents with intermittent high fever. Axial T2-weighted fast spin-echo image reveals lesion with hypointensity in central portion and hyperintensity in peripheral rim (arrows), indicating edematous change of its wall.

View larger version (112K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1E —45-year-old woman with hepatic mass who presents with intermittent high fever. Dynamic MR images through liver in arterial (E), portal venous (F), 3-minute delayed (G), 6-minute delayed (H), and 10-minute delayed (I) phases. In E, note marked enhancement in central portion of mass and peripheral rim that is hypointense compared with surrounding liver (arrows). In H, note progressive contrast medium washout, resulting in punctate appearance of mass (arrows). In I, peripheral rim reveals delayed enhancement compared with liver parenchyma (arrows). Splenic lesion shows progressive enhancement from portal venous phase to delayed phase images (arrowhead). Lesion shows no interval change at 2-year follow-up, findings suggestive of hamartoma.

View larger version (110K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1F —45-year-old woman with hepatic mass who presents with intermittent high fever. Dynamic MR images through liver in arterial (E), portal venous (F), 3-minute delayed (G), 6-minute delayed (H), and 10-minute delayed (I) phases. In E, note marked enhancement in central portion of mass and peripheral rim that is hypointense compared with surrounding liver (arrows). In H, note progressive contrast medium washout, resulting in punctate appearance of mass (arrows). In I, peripheral rim reveals delayed enhancement compared with liver parenchyma (arrows). Splenic lesion shows progressive enhancement from portal venous phase to delayed phase images (arrowhead). Lesion shows no interval change at 2-year follow-up, findings suggestive of hamartoma.

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1G —45-year-old woman with hepatic mass who presents with intermittent high fever. Dynamic MR images through liver in arterial (E), portal venous (F), 3-minute delayed (G), 6-minute delayed (H), and 10-minute delayed (I) phases. In E, note marked enhancement in central portion of mass and peripheral rim that is hypointense compared with surrounding liver (arrows). In H, note progressive contrast medium washout, resulting in punctate appearance of mass (arrows). In I, peripheral rim reveals delayed enhancement compared with liver parenchyma (arrows). Splenic lesion shows progressive enhancement from portal venous phase to delayed phase images (arrowhead). Lesion shows no interval change at 2-year follow-up, findings suggestive of hamartoma.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1H —45-year-old woman with hepatic mass who presents with intermittent high fever. Dynamic MR images through liver in arterial (E), portal venous (F), 3-minute delayed (G), 6-minute delayed (H), and 10-minute delayed (I) phases. In E, note marked enhancement in central portion of mass and peripheral rim that is hypointense compared with surrounding liver (arrows). In H, note progressive contrast medium washout, resulting in punctate appearance of mass (arrows). In I, peripheral rim reveals delayed enhancement compared with liver parenchyma (arrows). Splenic lesion shows progressive enhancement from portal venous phase to delayed phase images (arrowhead). Lesion shows no interval change at 2-year follow-up, findings suggestive of hamartoma.

View larger version (122K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1I —45-year-old woman with hepatic mass who presents with intermittent high fever. Dynamic MR images through liver in arterial (E), portal venous (F), 3-minute delayed (G), 6-minute delayed (H), and 10-minute delayed (I) phases. In E, note marked enhancement in central portion of mass and peripheral rim that is hypointense compared with surrounding liver (arrows). In H, note progressive contrast medium washout, resulting in punctate appearance of mass (arrows). In I, peripheral rim reveals delayed enhancement compared with liver parenchyma (arrows). Splenic lesion shows progressive enhancement from portal venous phase to delayed phase images (arrowhead). Lesion shows no interval change at 2-year follow-up, findings suggestive of hamartoma.

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1J —45-year-old woman with hepatic mass who presents with intermittent high fever. Abscess containing filamentous bacteria in matrix of sulfur granule is consistent with hepatic actinomycosis. (H and E, x200)

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