Hypodense liver lesions seen on CT. ABDOMEN:LIVER, BILIARY TRACT: The liver is of normal morphology size and signal intensity. Best seen on the postcontrast images are several relatively hypointense lesions in the right hepatic lobe with the largest measuring 1.2 x 1.1 cm (series 1 203/43). This lesion is minimally hyperintense to liver parenchyma on precontrast T1-weighted imaging. There is no associated arterial enhancement restricted diffusion or T2 weighted signal abnormality.There are several punctate intrinsically T1 weighted hyperintense foci in the liver (series 1 201/34). None of these lesions demonstrate arterial enhancement. Many of the lesions noted on the recent prior CT are not discretely seen on today's study.Note is made of mild prominence of the portal vein and hepatic veins with a dilated IVC.No intra or extrahepatic biliary ductal dilatation. Normally distended gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
Not all of the lesions seen on the recent CT are evident on today's MRI suggesting that these lesions are isointense to the liver. The largest lesion measuring 1.2 cm in the posterior right hepatic segment is minimally hyperintense to liver parenchyma on T1-weighted imaging without associated arterial enhancement, restricted diffusion or T2 weighted signal abnormality. Overall these findings suggest that these lesions are hepatocellular in origin. In the absence of known chronic liver disease or cancer these are unlikely to be malignant. Rather, given the patient's cardiac history and findings suggestive of elevated right-sided heart pressure, congestive hepatopathy should be considered with associated development of large regenerative nodules, although the lack of arterial enhancement is somewhat atypical. Hepatologic follow-up and work-up for congestive hepatopathy should be considered.