Wells MML, et al. – This study was undertaken to investigate the imaging appearance of hyperenhancing nodules arising in post–Fontan patients and to distinguish specific features best correlated with malignancy. As evidence accumulates, benign hyperenhancing masses in Fontan patients may illustrate washout and be mistaken for hepatocellular carcinoma by imaging criteria. It was noted that portal phase washout, mosaic architecture, elevated alpha fetoprotein levels and higher central venous pressures were associated with hepatocellular carcinoma in the atypical nodules observed in this population.