Approach to a patient with a liver lesion

common benign liver lesions. The European Association for the Study of the Liver (EASL) has comprehensive guidelines on the management of benign liver lesions.1 When considering if surgical resection is warranted in a patient with a benign liver lesion, there are key questions to consider: 1. Has there been growth of the lesion? 2. Is the lesion atypical or the diagnosis in question? 3. Is the patient having symptoms that could be attributed to the lesion? Magnetic resonance imaging (MRI) is the recommended imaging modality to most accurately characterize suspected benign liver lesions. Hepatic hemangioma, a blood filled cavity lined by a single layer of epithelial cells that derives its blood supply from the hepatic artery, is the most common benign liver lesion. Thought to be congenital, hemangiomas are more common in woman than men. In contradistinction to other common benign liver lesions, hemangiomas can be seen in cirrhosis, however with less frequency and often diminished in size. These lesions demonstrate avid T2 enhancement on MRI. When small, they may lack the classis features such as centripetal enhancement or a “filling” in, so they must be distinguished from a malignancy in cirrhosis, particularly intrahepatic cholangiocarcinoma (iCCA). Most hemangiomas are less than 5 cm; when greater than 10 cm they are known as a The presence of a liver lesion undoubtedly causes significant stress and anxiety not only for the patient but also for health care providers. It is important to realize that most liver lesions can be accurately diagnosed utilizing distinguishing features on imaging, laboratory data and clinical history. In lesions that remain indeterminate, a biopsy of the lesion may be warranted. Reviewing older imaging studies can provide invaluable information regarding the stability of the lesion in question and need for additional evaluation. Liver lesions in the setting of cirrhosis substantially alter the level of concern and clinical approach to testing. Aggregate data, including patient history, laboratory results (to calculate the the aspartate aminotransferase to platelet ratio index, or APRI), evidence of portal hypertension (pHTN) on imaging and physical signs suggestive of chronic liver disease should be used to assess patients individually.