Female, found gallbladder polyps 5 days, please diagnose!

"Department" hepatobiliary surgery patients, female, 37-year-old "main complaint" physical examination found that gallbladder polyps 5 days, not related treatment "current medical history" found gallbladder polyps 5 days .previous history" denied high blood pressure, diabetes history, occasional heart palpitations, denied hepatitis historyDeny a history of drug allergiesDenial of trauma and history of surgeryPhysical examination: the whole body skin, sdurdopha without yellow ingesame, flat abdomen, no gastrointestinal type and peristaltic waveFull abdominal soft, no tenderness, anti-jumppain and abdominal tensionThe liver and spleen were not touched, Murphy was positive and did not touch the visible swelling in his abdomen"Auxiliary examination" liver and bile pancreas multi-row flat sweep s-three-phase enhancement (image picture) flat-sweep inglised arterial period vein period delay period "discussion problem" How to diagnose?Comment 1: The lesions are located in the right lobe of the liver, for the blood-rich donor occupied lesions, CT flat sweep for low density shadow, the boundary is clear, enhance the scanning arterial period significantly strengthened, and then gradually dropped to the iso-density, I consider for liver adenomaComment 2: I first consider liver adenomas, followed by hepatic nodule hyperploff (FNH)Hepatic bureau-based nodule hyperplialhyper rarely appears tumor bleeding, and the tumor inside there are more central scars, enhanced scar tissue after the scanning is not strengthened, "star mann-" low density shadow, gate vein period and delay period density increasedIn summary, the patient's image performance is not very consistent, so the priority is given to liver adenomaComment 3: Patients are liver right lobe occupancy lesions, common diseases are liver adenoma, hepatic department-based nodule-like hyperploff, liver cell carcinoma and helixalysisHepatocellular carcinoma, generally have a history of liver disease, such as hepatitis, cirrhosis, AFP increase, CT-enhanced scanning artery period is significantly unevenly reinforced, the CT value of the gate period rapidly decreased, showing "fast-forward fast-out" characteristic performanceThe metastatic tumor rich in blood supply, metastatic tumor generally have a history of original onset, often more frequent, and the patient has no related tumor history, but also younger, do not consider metastasisTo sum up, I think liver adenoma and bureau-based nodule-like growth are possibleComment 4: I think it's liver-based nodule hyperpliesFrom the above image, the lesions artery period is significantly strengthened, but there are several appearances of non-reinforced low-density belt, which feels star-like scar"Star scar sign" is a more specific manifestation of hepatic lesions nodule-like hyperploff, so I think it is hepatic bureau-based nodule-like hyperplinterComment 5: Patients are younger women, asymptomatic, accidentally found, no chronic hepatitis history, no cirrhosisI first consider edeuryded liver adenomasThe lesions are swept to low density, the internal density is uniform, the artery period lesions are significantly reinforced, and then gradually decrease to the iso-density, which is characterized by "fast-forward slow-out" or "fast-forward"Final result: Liver adenoma Liver adenoma is an unusual liver tumor, prone to bleeding, rupture and potential malignancy, women are more frequentClinical studies have concluded that the occurrence of the disease is mainly related to hepatocellular nodule hyperpluse and oral contraceptives, in which steroid stakes are also highly susceptible, but there is no specific pathogenesisPathological examination showed that liver cells with abnormality loss of normal liver lobe structure due to arrangement disorders, with no normal gate and bile ducts, containing Kubo's cellsLiver adenoma is a blood-rich tumor, prone to bleeding, patients due to the occurrence of hemorrhagic acute abdominal disease to the hospital for treatment, no other abnormal clinical symptomsGenerally in the patient's physical examination can be found liver adenoma lesions, need to be clearly diagnosed and the patient to carry out targeted treatmentBecause its imaging characteristics are not obvious, clinical diagnosis is difficult, CT is an effective diagnostic methodCT flat sweep is shown as uniform isodensity or slightly low density, boundary clarity, spherical or leafy, often false envelopeTumor concurrent bleeding can be shown as high density lesions inside the tumor, and the internal lesions of those with long bleeding time are shown as low densityThe arterial period was significantly enhanced after the contrast enhancement, which then gradually decreased to the iso-densityIn some cases, the tumor edges have false envelopesThe literature reports that some tumors around the fatty degeneration, visible around the tumor formed a low density ring, think this is the ct-specific manifestations of liver adenocarcinoma Source: Image Park