Solitary Hepatic Nodule and Alagille Syndrome

A retrospective study (A Alhammad et al. JPGN 2016; 62: 226-32) of 55 children from 1999-2014 examined the frequency of a solitary hepatic nodule adjacent to the right portal vein as a potential diagnostic finding for Alagille syndrome.  Only 39 had appropriate imaging to examine.

Key findings:

  • In 12 (of 39) focal hepatic lesions were evident (11 were solitary).
  • The median diameter was 8.1 cm.
  • In those with pathology review, the cases were suggestive of a regenerative nodule.
  • In all but one case, the alpha-fetoprotein levels were normal.
  • 10 of these lesions were adjacent to the right portal vein.

One other point from the discussion:

  • ~21% of patients with Alagille require liver transplantation, primarily for unremitting cholestasis and pruritus

My take: Recognition of this entity will help avoid mistaking this lesion for hepatocellular carcinoma.

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