Investigations
AFP was normal at 8.93 ng/mL. Liver function tests showed a raised aspartate aminotransferase (73 U/L), normal Alanine aminotransferase (44 U/L), and ALP (233 U/L). Direct (0.24 mg/dl) and total (0.57 mg/dl) bilirubin were normal. A complete blood test revealed a white blood count of 5.5 x 1000/uL and hemoglobin levels of 12.7 g/dl. Renal function tests were also within the reference range, with creatinine measuring 0.75 mg/dL and BUN measuring 25 mg/dL.
Abdominal ultrasound revealed a large, lobulated right liver mass. A triphasic CT scan of the abdomen revealed a centrally non-enhancing mass that involves segments VI and VII and showed arterial and portal venous phase enhancement and washout on delayed phase (Figure 1). An incidental fusiform dilation, measuring 1.73cm in transverse dimension, of the celiac artery just after its takeoff is seen (Figures 1A, 1B and 2). The splenic, common hepatic, and left gastric arteries were seen separately arising from this fusiform dilation. No intramural filling defect or mural calcification was seen. Under aseptic precautions, an ultrasound-guided core needle biopsy of the right liver mass revealed focal nodular hyperplasia with no malignant features.