Objective: To describe an adult male with focal nodular hyperplasia (FNH) of the liver mimicking right lower rib pain.
Clinical Features: A 42-year-old male presented with right lower rib pain extending from the midsternal to the midaxillary line. The pain was sharp, aching, and radiating. He had a history of liver laceration after blunt abdominal trauma 34 years prior.
Interventions/outcomes: Murphy’s sign was positive, and there was reduced and painful right lateral thoracic bending. Palpation of the anterior right lower ribs elicited epigastric pain. An Activator instrument-assisted adjustment was performed on rib 8, which did not relieve the pain. The working diagnosis was intercostal neuralgia. The patient was referred for a sonographic examination of the gall bladder to discard acute cholecystitis. The sonogram revealed an incidental large hypervascular liver mass. Multiphase contrast abdominal computed tomography was performed to further characterise the lesion, demonstrating a mildly hyperattenuating, and moderately enhancing 8.8 cm mass in the left lobe of the liver, with hypoattenuating central scar, consistent with FNH.
Conclusion: Remote trauma may predispose patients to developing painful visceral lesions that mimic musculoskeletal pain. Diagnostic imaging plays a crucial role in securing the diagnosis and directing appropriate management.
Originally published as:
Guzman IMR, Halverson J. Focal nodular hyperplasia of the liver incidentally identified in a chiropractic patient with rib pain, a case report. In: Proceedings of the 16th Sacro Occipital Technique Research Conference, Nashville, Tennessee. 2025. p. 35.
This abstract is reproduced with permission of the publisher.
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