A 38-year-old woman is found incidentally to have a well-defined 6 cm hepatic lesion. MRI shows intense peripheral enhancement on arterial phase with centripetal fill-in on delayed images, isointense to blood pool. She is entirely asymptomatic and liver function tests are normal. The most appropriate management is:

• A Observation with serial imaging ✓
• B Transarterial embolization
• C Percutaneous biopsy of the lesion
• D Segmental liver resection

Explanation

The imaging pattern is diagnostic of cavernous hemangioma, the commonest benign liver tumour. An asymptomatic hemangioma requires no treatment irrespective of size; even giant lesions are managed expectantly unless they cause pain, rapid enlargement, or complications such as Kasabach-Merritt syndrome. Percutaneous biopsy risks catastrophic haemorrhage and is avoided when imaging is characteristic. Resection is reserved for symptomatic or enlarging lesions.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.