Imaging insights into pediatric liver masses: A comprehensive minireview for hepatology practice

Table 5 Summary of hepatic lesions encountered in all ages of the pediatric population

Lesion	Clinical features	Relevant laboratory investigations	Imaging appearances
Simple hepatic cyst	Asymptomatic; incidental finding; large cysts may cause abdominal pain or mass effect	Normal LFTs; no infection markers	US: Anechoic lesion with posterior acoustic enhancement. CT/MRI: Nonenhancing, fluid-filled lesion with thin wall
Choledochal cyst	Jaundice, abdominal pain, palpable mass, vomiting	LFTs abnormal in cholestasis	Magnetic resonance cholangiopancreatography/CT: Fusiform or saccular bile duct dilation showing communication with the biliary tree
Hydatid cyst	Asymptomatic in early stages; abdominal pain; rupture may cause anaphylaxis	Eosinophilia; positive Echinococcus serology	CT/MRI: Multiloculated cyst with calcifications, detached membrane (water lily sign)
Hepatic abscess	Fever, pain, jaundice, hepatomegaly; may mimic malignancy	Elevated white blood cell, CRP, ESR; positive blood cultures; abnormal LFTs	US: Hypoechoic/complex lesion, internal septations. CT: Peripheral enhancement, cluster sign, double target sign
Tuberculous liver lesions	Fever, weight loss, hepatosplenomegaly; often part of disseminated TB	Positive TB test, elevated CRP/ESR, possible acid fast bacilli in biopsy	CT/MRI: Calcified granulomas, miliary nodules, caseating necrosis, abscess formation
Lymphoma (hepatic involvement)	Fever, weight loss, hepatomegaly	Elevated lactate dehydrogenase; abnormal peripheral blood counts; possible lymphoma markers	US: Hypoechoic, ill-defined masses. CT/MRI: Multiple low-attenuation lesions, mild enhancement
Hepatic metastasis	Hepatomegaly, pain, systemic symptoms related to primary malignancy	Tumor markers (alpha-fetoprotein, catecholamines, etc.), abnormal LFTs	CT/MRI: Multiple lesions, variable enhancement, necrotic centers, target appearance

CRP: C-reactive protein; CT: Computed tomography; ESR: Erythrocyte sedimentation rate; LFTs: Liver function tests; MRI: Magnetic resonance imaging; TB: Tuberculosis; US: Ultrasound.