Two lesions which were described are identified as intermediate signal intensity on T2 weighted imaging. This is not characteristic of hemangiomata. The larger lesion in the peripheral subcapsular right lobe of the liver measures approx 1.8 cm in size and in the inferior right lobe measures 8-10mm in size. There are at least three additional lesions identified on the MRI of the liver, located at the dome of the liver measuring 10 mm in size, in the medial posterior right lobe of the liver measuring 8-10mm posterior to the right hepatic vein, and just below a 5-6mm lesion peripherally in the subcapsular posterior right liver. All of these lesions demonstrate intermediate signal and are not specific for hemangiomata. Following the administration of intravenous contrast they are visualized on the first phase following contrast administration consistent with hypervascular lesions. There may be one or two additional lesions in the right lobe of the liver, which are 3-4 mm. All of these are best seen on the first phase following contrast enhancement confirming their hypervascularity. They enhance homogeneously with no evidence for peripheral nodular enhanced hemangiomata. The etiology is therefore confirming the possibility of hypervascular metastasis. Other entities such as multiple hepatic adenomata is in the differential diagnosis, however, considered less likely. If there is no source for a primary neoplasm, consideration should be given perhaps to a PET Scan for further evaluation.
IMPRESSION: Multiple small lesions in the liver, with the largest lesion in the peripheral right lobe of the liver measuring 1.8 cm. The lesions demonstrate a hypervascular enhancement pattern, without definitive finding enhancement characteristics of hemangiomata. Therefore, the differential diagnosis includes hypervascular metastasis, vs benign hepatic adenomata. Other differential diagnosis includes regenerative nodules although there is no evidence for portal HTN or cirrhosis.
Thanks for your reply, Dr. Schiano. All of this somehow fell through the cracks, as my primary care phys never advised of the results or scheduled the biopsy.
Fast forward to today, I recently went to the ER due to excruciating cycle pain for suspected adenymiosis (sp). They did a CT scan and it noted a 1cm left adrenal mass along with few prominent retroperinoteal nodes. I have no means of getting a PET scan or anything like that. Im simply hoping its not cancerous.
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