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FOCAL NODULAR HYPERPLASIA GRANULOMATA
Category: Diagnostic Radiology
Abstract : Focal nodular hyperplasia This is a benign tumour made up of a proliferation
of liver cells with hepatocytes, Kupffer cells and biliary and fibrous elements.
It is most commonly found in young women and is usually discovered by chance,
being asymptomatic. Its ultrasound characteristics vary, and it may be
indistinguishable from hepatic adenoma. It tends to affect the caudate lobe and
Focal nodular hyperplasia
This is a benign tumour made up of a proliferation
of liver cells with hepatocytes, Kupffer cells and biliary and fibrous elements.
It is most commonly found in young women and is usually discovered by chance,
being asymptomatic. Its ultrasound characteristics vary, and it may be
indistinguishable from hepatic adenoma.
It tends to affect the caudate lobe and
has the appearance of a homogeneous mass often of similar echogenicity to the
liver. It presents a diagnostic difficulty both with CT and ultrasound, as its
characteristics can vary.
Colour Doppler shows an increased arterial flow
in the mass. The administration of an ultrasound contrast agent displays a
characteristic ‘spoked-wheel’ pattern of arteries with a central
scar.
The diagnosis can usually be confirmed on MRI scanning (which shows
a similar vascular pattern to that of ultrasound contrast scanning) but may
occasionally require biopsy proof. Management of this benign mass is usually
conservative, with ultrasound follow-up, once the diagnosis has been
established, but surgical resection may be necessary in larger
lesions.
Granuloma
Granulomata are benign liver masses which are
associated with chronic inflammatory liver diseases. They are particularly
associated with primary biliary cirrhosis, sarcoidosis or TB. They may be
multiple and small, in which case the liver often looks coarse and hyperechoic.
More often they are small discrete lesions which may be hypo- or isoechoic,
sometimes with a hypoechoic rim like a target, or calcified with distal
shadowing. They can undergo central necrosis.
Differential diagnoses
include metastases or regenerating nodules.
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