Fig. 2

Nineteen years old female patient presented with incidentally discovered hepatic focal lesion during abdominal ultrasound examination for abdominal pain. Imaging findings: grey scale B-mode ultrasonography (a): normal sized liver with a well-defined hypoechoic focal lesion seen in segment VII and VIII measuring 6 × 7.2 cm with 4.7 cm depth from the skin. ϖ Color-coded shear wave sono-elastography: the lesion showed mixed color with red foci (b, c, d), while the liver parenchyma showed dark blue color (e, f, g). ϖ Shear wave sono-elastography stiffness values of the focal lesion: E1 = 27.20 kPa (b), E2 = 27.16 kPa (c), and E3 = 26.48 kPa (d). Calculated average stiffness value of the lesion = 26.94 kPa. ϖ Shear wave sono-elastography stiffness values of the parenchyma: E1 = 7.14 kPa (e), E2 = 6.18 kPa (f), and E3 = 6.91 kPa (g). Calculated average stiffness value of the parenchyma = 6.74 kPa. • Lesion/parenchyma stiffness ratio = 3.99. ϖ Axial contrast enhanced triphasic CT study (arterial (h), portal (i), and delayed (j) phases): a well-defined lobulated hypervascular focal lesion is seen in segment VII and VIII with marked enhancement in the late arterial phase and evidence of a typical central scar within the lesion (black arrows). The portal phase demonstrates isoattenuation to the normal liver parenchyma. The delayed phase shows faint enhancement of the central scar. ϖ Pathology: focal nodular hyperplasia. ϖ Diagnosis: focal nodular hyperplasia (FNH)