Thread by @RyanChristieMD

#WetreadCoW Case 8

Hx: 30yo female w abdominal pain

Please answer with professionally appropriate gif responses only. No spoilers. wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad @RyanBPetersonMD @ER_Rad_Hanna @RadioGyan

#WetreadCoW Case 8 Answer: Hepatic Adenoma w hemorrhage

Multiple hyperenhancing hepatic masses in a young female. Largest in L lobe w hyperdensity (blood)➡️irreg contour w mild extracapsular hemorrhage #FOAMrad #radres #bodyrad #ERrad

Hepatic Adenomas:

-Benign
-m/c hepatic tumor in young females classically on OCPs
-stimulated by estrogen (OCPs, obesity, anabolic steroid use)
-typically asymptomatic
-prone to hemorrhage even➡️exsanguination!

#FOAMed #FOAMrad

Hepatic Adenomas Imaging:

Classic:
-solitary (>10 = adenomatosis)
-large (5-15cm) at dx
-subcapsular, R hepatic lobe
-well defined
-Ca++ uncommon (old bleed)

-US: varies
-CT: isodense to liver, early ⬆️ enh but iso- by PV phase
-hyperdense in fatty liver or w/ bleed
#radres

Hepatic Adenomas Imaging:

MR: T1 variable, T2 mild ⬆️, +fat ->phase drop out
-contrast: early arterial ⬆️ then iso on delay (like CT)
-hemorrhage can distort this

Nucs: photopenic defect on Tc-99 sulfur colloid (⬇️# & function of Kupffer cells ⭐️) #radres