Published online Mar 28, 2016. doi: 10.4254/wjh.v8.i9.446
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
Processing time: 189 Days and 9.7 Hours
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.
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.