Masquerading Hypervascular Exophytic Liver Nodule.

Patients with liver cirrhosis are at increased risk of developing hepatocellular carcinoma (HCC) and are placed on routine surveillance for HCC. Diagnosis algorithms are in place to guide clinicians in the evaluation of liver lesions detected during surveillance. Radiological assessments are critical with diagnostic criteria based on identification of typical hallmarks of HCCs on multiphasic computed tomography (CT) and dynamic contrast-enhanced magnetic resonance imaging (MRI). We report a patient with a hypervascular exophytic lesion indeterminate for HCC on CT imaging. While the detection of an exophytic arterially-enhancing lesion in an at-risk patient on CT imaging may prompt clinicians to treat the lesion as HCC without further evaluation, the patient underwent contrast-enhanced MRI with the lesion being eventually diagnosed as an exophytic haemangioma. Thus, no further action was necessary and the patient was continued on routine HCC surveillance. LEARNING POINTS: Radiological surveillance for hepatocellular carcinoma (HCC) is routine in patients at risk of HCC.Diagnosis algorithms that are in place for indeterminate lesions detected during HCC surveillance should be adhered to in order to achieve an accurate diagnosis.Sequential imaging with contrast-enhanced (gadoxetate) MRI should be used to obviate the need for an invasive biopsy when an exophytic lesion indeterminate for HCC is identified during CT imaging in a patient with liver cirrhosis, especially when a hepatic haemangioma remains a differential diagnosis. © EFIM 2020.