Fig. 7

A 38-year-old female with multiple liver lesions. This morbidly obese patient presented with acute abdominal pain and a solitary liver lesion in the lateral segment (white arrow) detected on axial contrast-enhanced CT (a). Peri-lesional complex fluid was noted (not shown) and the patient was taken to the operative theatre where a haemorrhagic liver lesion was resected. Four other liver lesions were noted at the time of surgery. The clinical and operative presumptive diagnosis was multiple hepatocellular adenomas, most likely of the inflammatory subtype. The original histopathological analysis described the resected lesion as an atypical focal nodular hyperplasia. Immunohistochemistry was performed several months later. Glutaminesynthetase stains depicted typical perivascular staining consistent with adenoma (not shown). b Catenin stains were negative and combined with the history of morbid obesity and metabolic syndrome a diagnosis of inflammatory adenoma was given. Follow-up MR examination was performed 2 years after surgery. Axial fat-suppressed T2W FSE images (b and c) demonstrate two lesions in the lateral segment (white arrow) and in the right anterior lobe (arrowhead) with increased T2W signal intensity relative to the liver. There is a faint peripheral rim of increased signal in the lateral segment lesion consistent with an atoll sign. Axial T1W images in (d) and opposed (e) phase demonstrate moderate diffuse hepatic steatosis and inhomogeneous intralesional steatosis (note the peripheral signal intensity drop) within both lesions (arrows). Also note the susceptibility artefact on the in-phase GRE image (d) at the lateral margin of the left lobe related to previous resection. Axial fat-suppressed T1W GRE images obtained after injection of extracellular gadolinium during the hepatic arterial (f), portal venous (g) and 5-min delayed (h) phases depict heterogeneous arterial enhancement that persists on delayed phases (arrows)