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    Go to the top of the page   ID: 20081216172615 Original case in english  More links about this topic on Pubmed (PubMed Reader)
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    Liver mass - focal nudular hyperplasia (FNH)
    Fritz Schneble. Liver mass - focal nudular hyperplasia (FNH). PedRad [serial online] vol 8, no. 12.
    URL: www.PedRad.info/?search=20081216172615


     
     Pediatric Radiology CasesImages to this case: There are Ultrasound-images available for this case. [ Ultrasound ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Fritz Schneble (KUNO/Kinder-Universitätskinderklinik-Ostbayern/Regensburg)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    15 Months  

     
     Pediatric Radiology CasesGender:

    Female  

     
     Pediatric Radiology CasesRegion-Organ:

    Abdomen-Liver  

     
     Pediatric Radiology CasesMost likely etiology:

    unknown  

     
     Pediatric Radiology CasesHistory:

    Clinical finings:
    Klinische Befunde:
    15 months old girl (Down syndrome, s/p acute myeloic leucemia) underwent oncologic follow up where a 3 cm solid and oval shaped liver mass in segment VIII was detected..
    Clinically, the girl is unremarkable and labs, including AFP were normal.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    The focal nodular hyperplasia (FNH) is a benign lesion of the liver of unknown etiology. In adults it has has been reported to have an incidence of 10/100 000. Therefore, FNH represents after hemangioma the second most common benign liver lesion (WANLESS et al. 1985; ZOLLER und LIESS 1994).  

     
     Pediatric Radiology CasesRadiological findings:


    Ultrasound 1 <- view Ultrasound 1

    Ultrasound 1: Solid liver lesion in liver segment VIII with mild displacement of right hepatic vein and IVC. Size of liver mass ca. 3,4 x 3 cm.




    Ultrasound 2 <- view Ultrasound 2

    Ultrasound 2: Color doppler ultrasound does not demonstrate increased vascularity.




    Ultrasound 3 <- view Ultrasound 3

    Ultrasound 3: Contrast enhanced sonography, arterial phase 17 sec. after Sonovue-i.v. application. The lesion demonstrates an early and strong centrifugal arterial enhancement. Also noted is a feeding arterial vessel.




    Ultrasound 4 <- view Ultrasound 4

    Ultrasound 4: Late phase 120 sec. after contrast application. The lesion is not discernable anymore from the surrounding liver parenchyma. Thus no evidence of a malignant liver lesion.



    Watch video


    Video: Contrast enhanced sonography (CEUS) of the liver, arterial phase 5-20 sec. after Sonovue bolus. Very early and strong centrifugal arterial enhancement. Also noted is a feeding arterial vessel.

     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    Total constellation (Consens)  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    Hepatoblastoma
    Metastasis
    Abscess  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    After regular follow up ultrasound exams, the finding stayed unchanged. FNH is usually clinically asymptomatic. Because of its good prognosis, generally no therapy is necassary.  

     
     Pediatric Radiology CasesComments of the author about the case:

    There are only a few publications about the incidence of FNH in children.
    Contrast enhanced ultrasonography (CEUS) of the liver has been established for over 10 years, especially for diagnosis of liver lesions. The contrast media (Levovist and esp. Sonovue) are currently not approved for usage in children. Contrast enhanced ultrasonography can be still performed in special cases, after comprehensive explanation and consent from parents. In this case, the confirmation of the benign nature of this lesion was possible and a biopsy of this difficult to access lesion and an MR exam under anesthesia could be avoided.  

     
     Pediatric Radiology CasesFirst description / History:

    N/A  

     
     Pediatric Radiology CasesLiterature:

    Wanless IR, Mawdsley C, Adams R. "On the pathogenesis of focal nodular hyperplasia of the liver." Hepatology 1985 ; 5(6): 1194-2000 ,
    Zoller WG, Liess H. "Fokalnoduläre Hyperplasie" . 1994 ; 119(15): 570

    2. Medline: Medline
    von Herbay A, Vogt C, Willers R, Häussinger D.
    Real-time imaging with the sonographic contrast agent SonoVue: differentiation
    between benign and malignant hepatic lesions.
    J Ultrasound Med. 2004 Dec;23(12):1557-68.

     

     
     Pediatric Radiology CasesKeywords:

    Liver mass, FNH, focal nodular hyperplasia, CEUS in children, child, childhood, pediatric radiology  

     
     Pediatric Radiology Cases Cite this article:

    Fritz Schneble. Liver mass - focal nudular hyperplasia (FNH). PedRad [serial online] vol 8, no. 12.
    URL: www.PedRad.info/?search=20081216172615  

     
     Pediatric Radiology Cases Read similar articles: with corresponding keywords
    in the same field: Abdomen-Liver
    or in the region: Abdomen
    or in the tissue/organ: Liver
    or with the etiology: unknown
     
     Pediatric Radiology CasesImages to this case: There are Ultrasound-images available for this case. [ Ultrasound ] View all modalities [ All ]   
     
    Liver mass - focal nudular hyperplasia (FNH)
    Fritz Schneble. Liver mass - focal nudular hyperplasia (FNH). PedRad [serial online] vol 8, no. 12.
    URL: www.PedRad.info/?search=20081216172615


     

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    Liver mass - focal nudular hyperplasia (FNH)
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    Search Fritz Schneble in Medline Fritz Schneble (7)   

    Liver mass - focal nudular hyperplasia (FNH)  
     
    Liver mass - focal nudular hyperplasia (FNH)
    Fritz Schneble. Liver mass - focal nudular hyperplasia (FNH). PedRad [serial online] vol 8, no. 12.
    URL: www.PedRad.info/?search=20081216172615


     
     
    Liver mass - focal nudular hyperplasia (FNH)
    Fritz Schneble. Liver mass - focal nudular hyperplasia (FNH). PedRad [serial online] vol 8, no. 12.
    URL: www.PedRad.info/?search=20081216172615


     

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    Liver mass - focal nudular hyperplasia (FNH)
    Fritz Schneble. Liver mass - focal nudular hyperplasia (FNH). PedRad [serial online] vol 8, no. 12.
    URL: www.PedRad.info/?search=20081216172615


     




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