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.