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World J Hepatol. Mar 28, 2016; 8(9): 446-451
Published online Mar 28, 2016. doi: 10.4254/wjh.v8.i9.446
Focal liver lesions found incidentally
Abdullah A Algarni, Abdullah H Alshuhri, Majed M Alonazi, Moustafa Mabrouk Mourad, Simon R Bramhall
Abdullah A Algarni, Abdullah H Alshuhri, Majed M Alonazi, Liver Unit, Prince Sultan Military Medical City, Riyadh 11159, Saudi Arabia
Moustafa Mabrouk Mourad, Simon R Bramhall, Department of General Surgery, Wye Valley NHS Trust, Hereford HR1 2ER, United Kingdom
Author contributions: Algarni AA designed the study; Algarni AA, Alshuhri AH, Alonazi MM and Mourad MM collected, analysed, interpreted the data, and drafted the article; Algarni AA and Bramhall SR designed the conception, critically revised the manuscript for important intellectual content, and made the final approval of the version to be published.
Conflict-of-interest statement: The investigators have not received any financial support for this study. None of the authors has any potential conflicting financial interests relevant to this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Abdullah A Algarni, MD, Liver Unit, Prince Sultan Military Medical City, PO Box 7897, Riyadh 11159, Saudi Arabia. aaalgarni@psmmc.med.sa
Telephone: +966-504-264119 Fax: +966-114-757863
Received: September 17, 2015
Peer-review started: September 21, 2015
First decision: October 30, 2015
Revised: January 31, 2016
Accepted: March 9, 2016
Article in press: March 14, 2016
Published online: March 28, 2016
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: Focal liver lesions, B-mode ultrasound, Ultrasound, Magnetic resonance, Fine needle biopsy, Computed tomography

Core tip: Focal liver lesions are being found more commonly, which may need further investigations. History and physical examination is essential part of work up. Blood work is an important adjunct in the patient’s journey. There are different modalities of imaging (B-mode ultrasound, contrast enhanced ultrasound, contrast enhanced computed tomography and contrast enhanced magnetic resonance); each has advantages and disadvantages. The decision of biopsy or surgery is kept for the treating team.