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

Viewable for logged on visitors (Log on)  

15 Months  

Female  

Abdomen-Liver  

unknown  

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.  

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).  

<- 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.




<- view Ultrasound 2

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




<- 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.




<- 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.





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.

 

Total constellation (Consens)  

Hepatoblastoma
Metastasis
Abscess  

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.  

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.  

N/A  

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:
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.

 

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

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