Another case, right upper quadrant pain. A markedly vascular liver lesion and then there's something in the porta. Now if that was the pancreas, you would say a neuroendocrine tumor metastatic to the liver. That's a thought. But if it's liver, what do you think about?

Hepatoma? Hepatomas are very vascular at times but not with vascular nodes like this – a classic hepatoma, that is. It doesn't look like hemangioma. It doesn't look like FNH. If it's hepatic adenoma, which it could be, then it would be a malignant transformation – hepatic adenoma into malignancy. Metastasis, let's say. Angiosarcoma, perhaps. Metastatic neuroendocrine tumor with nodes and liver is a possibility.

Here's just a few more images very nicely showing you the pancreas is OK, those masses are peripancreatic and represent adenopathy. There's some calcifications on the lesion best seen on the MIP imaging. So what are you think about? Again, a younger female.

Hepatoma is typically with cirrhosis but there is a variant of hepatoma in younger patients, mainly female: fibrolamellar hepatoma. Very vascular, younger patients, nodes are often vascular. What a great case.

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Liver CT Appearances: Fibrolamellar Hepatoma