Snapshot A 27-year-old female bodybuilder presents to the emergency department for worsening right upper quadrant pain. She states that her symptoms have slowly progressed since yesterday. On physical exam, you note an athletic female with well-developed muscles and the appearance of male-pattern facial hair growth. Her vitals are within normal limits. Her current medications include only OCP's and she is in general healthy. Suddenly, the patient's blood pressure drops to 90/30 mmHg and her pulse is 145/min. Introduction Hemangioma most common Hepatic adenoma incidence linked to anabolic steroids and oral contraceptives may rupture leading to severe intraperitoneal bleed Presentation Symptoms weight loss jaundice weakness pain RUQ or epigastric constant dull Physical exam hepatomegaly palpable mass distension (ascites) Evaluation Ultrasound CT Treatment Surgical resection only if danger of rupture symptomatic large amount of liver involved