Differential Diagnosis for a Central Scar in a Hepatic Lesion

• Single most likely diagnosis:
  • (a) focal nodular hyperplasia: This condition is known for often presenting with a central scar, which is a characteristic feature that helps in its diagnosis. The central scar is usually due to a fibrotic area and is a key distinguishing feature from other hepatic lesions.
• Other Likely diagnoses:
  • (b) hepatic adenoma: While not as commonly associated with a central scar as focal nodular hyperplasia, hepatic adenomas can occasionally present with this feature. However, the presence of a central scar in an adenoma is less typical and might suggest a specific subtype or a degenerative change.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • (e) hepatocellular carcinoma: Although a central scar is not a common feature of hepatocellular carcinoma (HCC), in rare cases, especially in the fibrolamellar subtype of HCC, a central scar can be present. Missing this diagnosis could be catastrophic due to the aggressive nature of HCC, making it crucial to consider, especially in the appropriate clinical context.
• Rare diagnoses:
  • (c) hemangioma: Hemangiomas are the most common benign liver lesions but are not typically associated with a central scar. While rare variants or degenerative changes might lead to the appearance of a scar, this would be an uncommon presentation.
  • (d) hamartoma: Also known as mesenchymal hamartomas, these are rare benign liver tumors that might show various imaging characteristics but are not classically associated with a central scar. Their presentation can be variable, but a central scar would be an unusual feature.