A 32-year-old woman on oral contraceptive pills presents with acute right upper quadrant pain. CT shows a 6 cm well-defined hepatic mass in segment VI with heterogeneous hyperenhancement in the arterial phase, areas of intralesional hemorrhage, and washout in the portal venous phase. No central scar is seen. The MOST likely diagnosis is:

• A Focal nodular hyperplasia (FNH)
• B Hepatocellular carcinoma
• C Hepatocellular adenoma ✓
• D Hypervascular metastasis

Explanation

Hepatocellular adenoma is associated with oral contraceptive use and characteristically shows arterial hyperenhancement with intralesional hemorrhage and washout, lacking a central scar. FNH typically has a central scar with delayed enhancement and does not hemorrhage. HCC in a young woman without cirrhosis is unlikely. Hypervascular metastases (e.g., from renal cell carcinoma) do not typically show intralesional hemorrhage as a dominant feature.

Reference: Diagnostic Imaging: Hepatobiliary and Pancreas (Federle), Standard edition ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.