A 40-year-old woman is found to have a 6 cm hepatic lesion on ultrasound done for vague right upper quadrant discomfort. MRI shows a well-defined lesion that is intensely and homogeneously enhanced on arterial phase with centripetal progressive filling on delayed phases, matching blood pool signal. Alpha-fetoprotein and CA 19-9 are normal. What is the correct management?
- A Percutaneous needle biopsy to confirm the diagnosis
- B Transarterial embolisation to prevent rupture
- C Reassurance with no treatment if asymptomatic ✓
- D Right hepatectomy because of size above 5 cm
Correct answer: C. Reassurance with no treatment if asymptomatic
Explanation
The imaging pattern of peripheral nodular arterial enhancement with centripetal fill-in matching blood pool is characteristic of cavernous haemangioma, the most common benign liver tumour. Asymptomatic lesions require no treatment regardless of size; resection is reserved for incapacitating pain, rapid growth, or diagnostic doubt. Percutaneous biopsy is specifically avoided due to risk of haemorrhage. Rupture is rare, so prophylactic embolisation is not indicated.
Reference: Schwartz's Principles of Surgery, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.