Published online Jul 26, 2021. doi: 10.12998/wjcc.v9.i21.5948
Peer-review started: November 19, 2020
First decision: December 28, 2020
Revised: January 17, 2021
Accepted: April 6, 2021
Article in press: April 6, 2021
Published online: July 26, 2021
Focal liver lesions (FLLs) are abnormal masses that are distinguishable from the surrounding liver parenchyma, solid or cystic and may be benign or malignant. They are usually detected incidentally on abdominal examinations. The classification of FLLs is very important as it directly determines the diagnosis and treatment of patients.
A 46-year-old male patient was admitted into the hospital with tarry stool, during the investigation of this issue an incidental FLL was detected. Upon further investigation of this “incidentaloma” computerized tomography and magnetic resonance imaging reached contradictory conclusions. The lesion was then further investigated using contrast-enhanced ultrasound (CEUS) with an initial diagnosis of idiopathic FLL was acquired and observation of the FLL over time need for final diagnosis, however in the follow up the FLL disappeared spontaneously.
CEUSs value for characterization of FLLs is undeniable, especially when other methods produce inconsistent results, is undeniable but with its limitations. Why and how the FLL disappeared is not known, and can be only hypothesized it was a pseudolesion.
Core Tip: This case report describes a patient with an incidentally detected focal liver lesion (FLL) in a routine computerized tomography (CT) scan preformed for an unrelated issue. After further investigation of the FLL, the CT scans gave a conclusion of hepatic hemangioma and couldn’t exclude neoplastic, while the magnetic resonance imaging scans diagnosed the lesion as small hepatocellular carcinoma, thus contrast-enhanced ultrasound (CEUS) was preformed to accurately diagnose the lesion which initially gave us a possible diagnosis of a benign idiopathic lesion, and observation over time required for a final diagnosis. In the 1, 3, 6 and 12 mo post-discharge follow up, the lesion spontaneously disappeared, and no final diagnosis was acquired as to what FLL might be. CEUS is very useful at diagnosing FLL but still has its limitations.