Dr. Pepe’s Diploma Casebook: Case 36 – SOLVED!

Dear friends,

Presenting liver MR images of a 63-year-old diabetic woman with mild pain in the RUQ over the last few weeks.

Possible diagnoses:

1. Hepatocellular carcinoma
2. Hepatocellular adenoma
3. Liver angiomyolipoma
4. Liver metastases

A 63 -year-old diabetic woman with mild abdominal pain in the right upper quadrant over the last few weeks

A 63 -year-old diabetic woman with mild abdominal pain in the right upper quadrant over the last few weeks

Click here for the answer to case #36

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    10 Responses to : Dr. Pepe’s Diploma Casebook: Case 36 – SOLVED!

    1. Dr. Os says:

      A large oval shape well defined outline focal lesion is seen at segment VII of the liver. It has high signal intensity at T1WI.
      It posterior compartment shows different signal intensity between IP and OP; denoting fatty component.
      with available MRI sequences ANGIOMYOLIPOMA is suggested.
      However post Gd enhanced studies in arterial phase and subtraction IP-OP sequence is recommended to exclude malignancy.

    2. Genchi bari Italia says:

      Angiomiolipoma: Formazione spazio-occupante, a margini netti, senza capsula di delimitazione, disomogenea, per le diverse componenti tessutali, in OP ed IP.

    3. Maria says:

      Angiomyolipoma. It consists of macroscopic fat which does not show low signal on opposed phase image!

    4. Rahul says:

      Loss of signal within the segment VI lesion on the out of phase T1WI suggests intracellular lipid, this is against hepatic angiomyolipoma. In a non-cirrhotic patient I would favor a hepatic adenoma, however a lipid containing HCC remains a possibility. Correlation with fat suppressed pre and post contrast imaging is needed to exclude macroscopic fat as a cause for the intrinsic T1 high signal, in which case an angiomyolipoma would be possible, although rare in the absence of tuberous sclerosis. In the presence of pain haemorrhage could also explain the intrinsic high T1 signal.

    5. Maria says:

      Hemangioma is a possibility. Simply because it contains fat and has high signal on T2.

    6. Ricardo Macareno says:

      Liver angiomyolipoma

    7. genchi bari italia says:

      ….scusa dr Pepe ma al 2° segmento epatico è visibile un’altra immagine nodulare, iperintensa in IP:questo cambia tutta la diagnosi!!!!

      • Dr. Pepe says:

        Checked with Dr J Martin, who prepared the case. He congratulates you for your perception, but what seems a nodule is an artifact created by the aortic pulsation.
        Well done!

    8. Humoud says:

      The lesion contains macroscopic far and has heterogenous T1
      Signal. This may represents an adenoma or angiomyolipoma.. Need intravenous contrast