Incidental Hepatic Lesion in Young Female

Case at a Glance

A 29-year-old healthy female athlete presented to the emergency department for an unrelated complaint. Incidental CT imaging revealed a hyperdense vascular mass in the liver, with radiologist recommendations for MRI follow-up to differentiate between benign etiologies such as hepatic adenoma or focal nodular hyperplasia.

Patient's Story

The patient is a 29-year-old female with an active lifestyle, regular exercise routine, and no significant past medical history. She has been taking oral contraceptive pills for approximately 10 years. She visited the emergency department for an unrelated medical concern that required abdominal CT imaging. The patient expressed significant anxiety upon learning about the incidental liver finding, as she had no symptoms or prior awareness of any liver abnormalities.

Initial Assessment

Physical examination was unremarkable with normal vital signs. The patient appeared well and had no abdominal pain, distension, or palpable masses. Laboratory work-up was not initially performed as the finding was incidental. The patient's body mass index was within normal limits at approximately 21 kg/m².

The Diagnostic Journey

CT scan of the abdomen revealed partial visualization of a hyperdense vascular mass in the upper abdomen, specifically involving the liver. The radiologist noted that the imaging characteristics and clinical context (young female on long-term oral contraceptives) suggested benign etiology. Further characterization with MRI liver with and without IV contrast was recommended for definitive diagnosis.

Final Diagnosis

Pending MRI results - differential diagnosis includes hepatic adenoma or focal nodular hyperplasia (FNH), both benign liver lesions commonly seen in young women taking oral contraceptives.

Treatment Plan

Non-emergent MRI liver with and without contrast to be scheduled within 2-4 weeks. Patient counseling regarding the likely benign nature of the finding. Discussion about oral contraceptive use and its association with benign liver lesions. Follow-up appointment scheduled post-MRI to review results and discuss management options.

Outcome and Follow-up

Patient was reassured about the likely benign nature of the finding. She was educated about the association between long-term oral contraceptive use and benign liver lesions such as hepatic adenomas and FNH. Awaiting MRI results for definitive characterization and to guide further management decisions.