A 28-year-old woman has an incidentally detected 4 cm left lobe liver lesion. MRI shows intense arterial enhancement with a central T2-bright stellate area, and the hepatobiliary phase shows retained contrast within the lesion. The most appropriate management is:

• A Laparoscopic left lateral sectionectomy
• B Percutaneous biopsy to exclude malignancy
• C Transarterial embolization
• D Reassurance with no treatment or restriction of activity ✓

Explanation

The central scar with retained hepatobiliary contrast is characteristic of focal nodular hyperplasia, a benign hyperplastic response to a congenital arteriovenous malformation that has essentially no malignant potential and negligible bleeding risk. No surgical intervention is required. Biopsy is unnecessary when imaging is typical and may cause haemorrhage, and resection or embolization are treatments for adenoma or symptomatic lesions rather than FNH.

Reference: Blumgart's Surgery of the Liver, Biliary Tract and Pancreas, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.