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Case Reports
. 2020 Apr 7;104(1):16.
doi: 10.5334/jbsr.2088.

A Challenging Case of Solitary Necrotic Nodules of the Liver Mimicking Hepatic Metastases: CT, MRI, and PET-CT Findings

Ji Yeon Hwang  1 , Ji Eun Lee  1 , Min Jung Jung  1
Affiliations
Case Reports

A Challenging Case of Solitary Necrotic Nodules of the Liver Mimicking Hepatic Metastases: CT, MRI, and PET-CT Findings

Ji Yeon Hwang et al. J Belg Soc Radiol. .

Abstract

Main teaching point: Solitary necrotic nodules of the liver can be multiple and usually appear as hypovascular nodules mimicking hepatic metastases, but they are relatively small and located in the subcapsular areas of the liver. We report a very rare case of multiple solitary necrotic nodules of the liver mimicking hepatic metastases in a patient with previous history of lung cancer. The lesions appeared as low-attenuated or low-signal intensity nodules with thin rim enhancement on both contrast-enhanced computed tomography (CT) and magnetic resonance (MR) imaging, making them difficult to differentiate from hepatic metastases. This rare benign entity should be kept in mind, especially when lesions are small and located in the subcapsular areas of the liver.

Keywords: computed tomography; liver metastasis; magnetic resonance imaging; positron-emission tomography/computed tomography; solitary necrotic nodule.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

Figure 1
Figure 1
Contrast-enhanced axial CT (computed tomography) images in the portal phase (A, B) showed two small, rim-enhancing, low-attenuated nodules (arrow) in the subcapsular area of liver segments 2 and 8.
Figure 2
Figure 2
(A) Axial, respiratory-triggered, single-shot, T2-weighted MR (magnetic resonance) imaging revealed a nodule (arrow) in liver segment 2, showing a target appearance with intermediate high signal intensity and central, dot-like, bright signal intensity. (B) On unenhanced, T1-weighted MR imaging, the lesion (arrow) was nearly iso-signal intensity to the normal liver parenchyma. (C) On contrast-enhanced arterial phase MR imaging, the lesion (arrow) showed rim-enhancement. (D) On the hepatobiliary phase, the lesion (arrow) demonstrated low signal intensity. (E) On diffusion-weighted image (b = 800 s/mm2), the lesion (arrow) showed high signal intensity.
Figure 3
Figure 3
On 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) positron-emission tomography (PET)/CT (A, B), both lesions showed increased FDG uptake.
Figure 4
Figure 4
(A) Scan power view of the liver specimen revealed a necrotic nodule with central cystic space and surrounded by fibrous tissue (Hematoxylin and eosin, ×10). (B) The edge of the nodule showed granulomatous inflammation consisting of epithelioid histiocytes, lymphocytes, some eosinophils, and a few giant cells (Hematoxylin and eosin, ×100).
See this image and copyright information in PMC

References

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