Hepatic adenoma - spontaneous rupture
Right hypochondrial pain
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Heterogeneous mass measuring 13.3 x 11.1 x 9.7 cm, seen involving segment VIII and segment V in the right hepatic lobe, with hyperdense subsapsular hematoma at corresponding lateral hepatic surface and free intra-peritoneal hemorrhage. Non-contrast CT scan shows that the mass has internal areas of high attenuation, which are suggestive of acute hemorrhage and irregular heterogeneous hypoattenuating areas of old hemorrhage. Triphasic study revealed heterogeneously enhancing mass, with no evidence of vascular or biliary invasion, no lymphadenopathy.
A well marginated solid hepatic mass with benign features, showing spontaneous rupture (in a non-cirrhotic liver revealed by prior ultrasonography) in an obese female patient, with a history of long use of oral contraceptive pills; favors the diagnosis of hepatic adenoma rather than HCC.