A 41-year-old woman has an incidental 8 cm lesion in the right lobe of the liver. Dynamic MRI shows intense homogeneous arterial enhancement with centripetal fill-in on delayed phases and no washout. She is asymptomatic and haemodynamically normal. The most appropriate management is:

• A Resection because lesions above 5 cm carry a high risk of rupture
• B Transarterial embolisation to induce shrinkage
• C Liver transplantation
• D Observation with reassurance, no intervention required ✓

Explanation

The imaging pattern of peripheral nodular enhancement with centripetal progression and no washout is diagnostic of cavernous haemangioma, the most common benign liver tumour. Even giant haemangiomas are managed conservatively unless they cause disabling symptoms, rapid growth, or diagnostic uncertainty, because spontaneous rupture is exceedingly rare. Resection and embolisation are reserved for symptomatic lesions, and transplantation has no role here.

Reference: Schwartz's Principles of Surgery, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.