Focal liver lesions found incidentally

Abstract

Incidentally found focal liver lesions are a common finding and a reason for referral to hepatobiliary service. They are often discovered in patients with history of liver cirrhosis, colorectal cancer, incidentally during work up for abdominal pain or in a trauma setting. Specific points should considered during history taking such as risk factors of liver cirrhosis; hepatitis, alcohol consumption, substance exposure or use of oral contraceptive pills and metabolic syndromes. Full blood count, liver function test and tumor markers can act as a guide to minimize the differential diagnosis and to categorize the degree of liver disease. Imaging should start with B-mode ultrasound. If available, contrast enhanced ultrasound is a feasible, safe, cost effective option and increases the ability to reach a diagnosis. Contrast enhanced computed tomography should be considered next. It is more accurate in diagnosis and better to study anatomy for possible operation. Contrast enhanced magnetic resonance is the gold standard with the highest sensitivity. If doubt still remains, the options are biopsy or surgical excision.

Keywords: B-mode ultrasound; Computed tomography; Fine needle biopsy; Focal liver lesions; Magnetic resonance; Ultrasound.

Figure 1

Contrast enhanced computed tomography images of hepatocellular carcinoma. A 55 years old male, diabetic, presented with upper abdominal pain (arrows shows the lesion in different phases with clear washout at the venous phase).

Figure 2

Contrast enhanced magnetic resonance images of focal nodular hyperplasia. A 30 years old female, medically free, had abdominal pain; ultrasonography showed gallstones and liver lesion (arrows shows the lesion with the characteristic central scar of FNH).