Case 393: Sinusoidal dilatation

Diagnostic Categories:

Clinical Presentation:

26-year-old woman with reported hemangiomas and currently on oral contraceptives. Questionable adenoma.

MR: Mimicking hepatic congestion.

Imaging Findings:

MR demonstrates peripheral linear anomalies of the parenchyma mainly in the right lobe in a perpendicular pattern to the capsule, which are mildly hypointense on T1, moderately hyperintense on T2 with delayed fern-like hypoperfusion on portal venous phase representing delayed perfusion. Equilibrium phase demonstrates patchy areas of late enhancement representing stagnant blood flow. No diffusion restriction, given vascular nature of the anomaly.

Findings are typical for sinusoidal dilatation, here most likely due to oral contraceptives, a rare cause. 

Compare to other cases where findings in older patients are more pronounced throughout the entire liver with mosaic perfusion pattern, representing hepatic congestion due to cardiac insufficiency.