Background: Chemotherapy exerts a multitude of effects on all organ systems including the liver. Chemotherapyinduced liver changes are widely discussed in the literature and include hepatitis, hepatic steatosis, cholestasis, nodular hyperplasia, and veno-occlusive disease among others. The exact mechanism of which nodular hyperplasia is affected by chemotherapy is controversial but some experts suggest an alteration in blood supply might lead to exaggerated focal regeneration. Objectives: This study aimed to discuss an unusual effect of chemotherapeutic agents on pre-existing focal nodular hyperplasia with a short literature review. Patient and methods: A case report of 67 years old bedridden male patient presenting to the hospital with a 1- month history of gross hematuria who was treated with chemotherapy. Results: Our case showed an interval size reduction of a pre-treatment documented FNH in a patient with muscleinvasive urinary bladder cancer who was treated with a chemotherapy regimen of GemCarbo. This report also emphasizes the importance of enhanced MRI with hepatobiliary contrast agents in the evaluation of equivocal liver lesions in cancer patients to avoid misdiagnosis of distant metastasis. Conclusion: FNH is a common focal hepatic lesion and frequently seen in oncology patients during either initial evaluation or at follow up. Diagnostic radiologists should be aware of the expected imaging findings of various types of hepatic lesions and the effect of the medications the patient is receiving to avoid over-staging oncology patients.