Fig. 1. CT scan.	Fig. 2. SMA arteriogram: replaced right hepatic artery.

Case Reference No. CC-497-08 A 42-year-old female Jehovah's Witness presented with acute right upper quadrant abdominal pain and hypotension which was stabilized. History revealed no trauma, but was significant for oral contraceptive use. CT scan (Fig. 1) showed a subcapsular hematoma with partially enhancing mass in the right lobe. An MRI (not shown) also showed the mass at the edge of the hematoma. A presumptive diagnosis of adenoma was made. Because of her religious beliefs, surgery was contraindicated as transfusion would almost certainly be necessary. Embolization was requested. Diagnostic arteriography (Fig. 2) revealed a replaced common hepatic artery to the SMA. Selective proper hepatic arteriogram (Fig. 3) showed an enhancing mass at the edge of an avascular area representing the hematoma. Superselective arteriography with a microcatheter showed the mass well (Fig. 4). Embolization was performed with 350-500 micron PVA particles (Fig. 5). The patient recovered uneventfully and is doing well at 22-month follow-up. Questions 1) Would anyone insist on a biopsy of this lesion (difficult to see on the CT/MRI) prior to therapy? 2) Should this be considered mainstream therapy for this type of lesion (we still see a lot of surgery done for these)? 3) Would any other embolic agent be suitable/preferable?

Fig. 3. Later image. Fig. 4. Superselective angiography. Fig. 5. Post embolization angiogram.