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Acute-onset abdominal pain in a woman in her 30s
  1. Rory O’Donohoe1,
  2. Samantha Fitzsimmons2,
  3. Timothy J C Bryant1
  1. 1 Department of Radiology, University Hospital Southampton, Southampton, UK
  2. 2 Department of Cardiology, University Hospital Southampton, Southampton, UK
  1. Correspondence to Dr Rory O’Donohoe, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK; roryodonohoe{at}


Clinical introduction A woman in her 30s presented to the emergency department with sudden-onset abdominal pain with hypotension and tachycardia. She gave a history of congenital heart disease for which she had previously undergone multiple operations. On examination she demonstrated right upper quadrant tenderness. She underwent an urgent multiphase CT (figure 1A–C).

Figure 1

(A) Arterial phase coronal CT. (B) Arterial phase axial CT. (C) Portal venous phase axial CT.

Question What is the underlying liver pathology?

  1. Hepatocellular adenoma

  2. Cholangiocarcinoma

  3. Hepatocellular carcinoma

  4. Focal nodular hyperplasia

  5. Hepatoblastoma


  • Fontan physiology

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  • Contributors ROD prepared the manuscript and images. SF and TJCB participated in the care of the patient and critically reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.