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Acute-onset abdominal pain in a woman in her 30s


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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