Focal hepatic lesions in the pediatric population are rare and are usually found on incidental imaging of the abdomen. The most common lesions are focal nodular hyperplasia and hemangioma, but the differential diagnosis is quite broad. We present a case of an adolescent male who was found to have a large pseudorheumatoid nodule of the liver that was successfully resected. Only one previous case is reported in the literature and none in the pediatric age group. © 2006 Elsevier Inc. All rights reserved.