Benign liver lesions are noncancerous growths in the liver, such as hemangiomas, focal nodular hyperplasia, simple cysts and hepatic adenomas. Most are found by chance on imaging, cause no symptoms and only need the right test to confirm they are harmless.
Key symptoms
- Usually no symptoms; found on a scan done for another reason
- Dull fullness or pain in the right upper belly if large
- Early fullness when eating with very large lesions
- Sudden severe pain if an adenoma bleeds
What you find on exam
- Often a normal exam
- Enlarged liver edge in large lesions
- Look for signs of chronic liver disease, which raise concern for cancer
- Check for low blood pressure if bleeding is suspected
Tests
- Liver tests and blood count
- Multiphase contrast CT or MRI to identify the lesion type
- Alpha-fetoprotein if there is cirrhosis or chronic hepatitis
- Biopsy only when imaging cannot tell the lesion apart from cancer
Treatment basics
- Hemangiomas, simple cysts and focal nodular hyperplasia usually need no treatment
- Stop estrogen-containing birth control if an adenoma is found
- Surgery or embolization for adenomas larger than 5 cm or with bleeding
- Follow-up imaging when the type or growth is uncertain
Red flags
- Sudden abdominal pain with low blood pressure
- Lesion in a patient with cirrhosis or hepatitis B
- Weight loss, jaundice or a growing mass on repeat imaging
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.