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Case Reports
. 2017 Dec 20;9(12):e1975.
doi: 10.7759/cureus.1975.

Spontaneous Rupture of a Hepatic Adenoma: Diagnostic Nuances and the Necessity of Followup

Preston F Ashby  1 , Chelsea Alfafara  2 , Albert Amini  3 , Richard Amini  4
Affiliations
Case Reports

Spontaneous Rupture of a Hepatic Adenoma: Diagnostic Nuances and the Necessity of Followup

Preston F Ashby et al. Cureus. .

Abstract

We present the case of a young female on oral contraceptives (OCs) who was diagnosed with focal nodular hyperplasia (FNH) and remained on oral contraceptives. Months later, the patient presented with acute abdominal pain and intratumoral hemorrhage in the liver. The patient was taken to the operating room (OR) and was diagnosed with a ruptured hepatic adenoma (HA). We review the key diagnostic features of FNH and HA, the different management guidelines including use of OCs, and potential surgical indications. HA compared to FNH has a significantly higher rate of sequelae despite being a benign lesion, thus providers must accurately distinguish between the two diagnoses to prevent potential morbidity and mortality.

Keywords: focal nodular hyperplasia; hepatic adenoma; hepatic hemangioma.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Computed tomography one year prior to presentation.
Computed tomography demonstrates a 12.6 cm x 12.1 cm x 8.6 cm right liver mass with central stellate scar present, consistent with focal nodular hyperplasia (FNH). Followup with non-emergent outpatient magnetic resonance imaging (MRI) recommended.
Figure 2
Figure 2. Computed tomography on the day of presentation.
Computed tomography demonstrating a 16 cm x 13 cm x 13 cm right liver mass with central stellate scar consistent with focal nodular hyperplasia (FNH).
Figure 3
Figure 3. Magnetic resonance imaging of the abdomen.
The magnetic resonance imaging (MRI) of the abdomen demonstrated a 15.3 cm x 12.5 cm x 14.1 cm heterogeneous mass straddling the right and left lobe of the liver. There was also peripheral enhancement consistent with hemorrhage.
Figure 4
Figure 4. Postoperative image of the resected hepatic adenoma.
The patient underwent a laparoscopic-assisted extended right hepatectomy including parts of segment 4 and 1.
Figure 5
Figure 5. Differentiating focal nodular hyperplasia from hepatic adenoma.
See this image and copyright information in PMC

References

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