Diagnostic Ultrasound - Abdomen and Pelvis

Hepatic Adenoma
Diagnoses: Liver
TERMINOLOGY
• Hepatocellular adenoma (HCA) or liver cell adenoma
• 2nd most frequent hepatic tumor in young women after
focal nodular hyperplasia (FNH)
IMAGING
• Best diagnostic clue: Heterogeneous, hypervascular mass ±
hemorrhage in young woman on oral contraceptives
• Subcapsular right hepatic lobe (75%)
• Round or mildly lobulated, well-defined borders
• Hypo-/iso-/hyperechoic mass
• Complex heterogeneous mixed echogenicity mass
• Hypoechoic halo of compressed liver tissue with multiple
vessels
• Larger lesions prone to intratumoral hemorrhage or
rupture with intraperitoneal hemorrhage
• Best imaging tool: Ultrasound for lesion detection, guiding
biopsy, and monitoring size
KEY FACTS
• Liver-specific MR contrast agents have high accuracy in
distinguishing HCA from other liver lesions
TOP DIFFERENTIAL DIAGNOSES
• Hemangioma
• Focal nodular hyperplasia (FNH)
• Hepatocellular carcinoma (HCC)
CLINICAL ISSUES
• Definitive diagnosis and subtype with biopsy
• Molecular classification (4 subtypes) helps determine
prognosis and management
○ β-catenin-mutated subtype prone to malignant
degeneration
• Lesions > 6 cm more prone to hemorrhage
DIAGNOSTIC CHECKLIST
• Rule out other liver tumors with similar imaging features,
such as HCC or FNH
(Left) Transverse
transabdominal ultrasound
demonstrates a predominantly
hyperechoic adenoma ſt with
hypoechoic central areas ,
which could represent
hemorrhage or necrosis.
(Right) Transverse color
Doppler ultrasound of the left
lobe of the liver demonstrates
a hyperechoic adenoma ſt
with large peripheral vessels
.
(Left) Transverse
transabdominal grayscale
ultrasound demonstrates a
heterogeneously hypoechoic
adenoma ſt. Heterogeneous
areas likely represent necrosis
from prior hemorrhage.
(Right) Transverse color
Doppler ultrasound in the
same patient shows peripheral
large vessels ſt bordering the
hypoechoic hepatic adenoma
.
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