Background

Mass lesions in liver in pregnancy are rare including hemangiomas, focal nodular hyperplasia, and
hepatocellular adenomas and carcinomas. Therefore, it can present with unique challemges with many
diagnostic and management uncertainties. This is a case of large liver nodule suggestive of Focal
Nodular Hyperplasia diagnosed incidentally during routine ultrasound scan at 21 weeks of gestation.

Case Presentation

Background

Mass lesions in liver in pregnancy are rare including hemangiomas, focal nodular hyperplasia, and
hepatocellular adenomas and carcinomas. Therefore, it can present with unique challemges with many
diagnostic and management uncertainties. This is a case of large liver nodule suggestive of Focal
Nodular Hyperplasia diagnosed incidentally during routine ultrasound scan at 21 weeks of gestation.

History

31 year old

POG- 21 weeks

G2P1C1

Antenataly uncomplicated

No nausea/ vomiting or
jaundice

Examination

BMI- 27kg/m-2

Bp- 110/70

Normal physical
examination

SFH-21cm

Investigations

USS- Normal fetal parameters

- Hypoechoic liver lesion

NC-MRI- Large heterogenous mass with lobulated outlines
with features suggestive of focal nodular hyperplasia

- Slight compression on inferior vena cava
but patent

CEMRI- Well defined focal liver lesion in segment VII
extending to segment VI measuring 8.1x6.6x8.2cm with a T2
hyper intense central scar suggestve of focal nodular
hyperplasia

- No other focal liver lesions or diffuse
parenchymal abnormality of liver

- No lymphadenopathy

Liver biochemistry- Normal

Discussion

Liver lesions during pregnancy are uncommon but can pose challenges in diagnosis and
management and the need to avoid harm to the fetus. Focal nodular hyperplasia is a benign
liver lesion that is typically asymptomatic and found incidentally on imaging. MRI can be used
to distinguish it from adenomas. The use of MRI during pregnancy is associated with concerns
among patients and health professionals with regards to fetal safety. The primary concern is
the exposure of the fetus to contrast, gadolinium, due to its ability to cross the placental barrier
into fetal circulation. Although this is being actively investigated, no studies have reported any
adverse effects when human fetuses were exposed in utero up to date.

Conclusion

Lack of evidence in managing large
liver lesions in pregnancy make the
management difficulties.

Robust evidence in diagnosis and
managemnet of large liver lesions,
is need to address these
challenges

References

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