Focal Liver Lesions Flashcards
(21 cards)
For focal liver lesion of unknown etiology, recommend multiphase contrast-enhanced imaging, preferably MRI or CT w/ late arterial, portal venous, and delayed phases
strong, low evidence
Recommend discontinuation of OCPs or IUDs that are hormone-impregnated in patients w/ hepatic adenomas
strong, low evidence
For focal liver lesion of uncertain etiology, recommend multiphase contrast-enhanced imaging, preferably MRI or CT w/ late arterial, portal venous, and delayed phases
strong, low evidence
Recommend discontinuation of OCPs or IUDs that are hormone-impregnated in patients w/ hepatic adenomas
strong, low evidence
Suggest encouraging weight loss in overweight or obese patients w/ hepatic adenomas
conditional, very low evidence
Suggest multiphasic liver imaging (preferable MRI) over standard cross-sectional imaging modalities to accurately distinguish hepatic adenomas from other benign or malignant liver lesions
conditional, very low evidence
In women w/ hepatic adenoma < 5cm, suggest discontinuation of exogenous hormones and advise weight loss for overweight or obese individuals
conditional, very low
In women w/ hepatic adenoma < 5cm, suggest surveillance w/ contrast-enhanced imaging modalities every 6 months fro 2 years, then annually thereafter
conditional, low evidence
In patients w/ hepatic adenomas requiring treatment who are unable to undergo surgical resection, suggest embolization or ablation as alternative treatment approach
conditional, low evidence
In patients w/ ruptured hepatic adenomas, suggest hemodynamic stabilization followed by embolization and/or surgical resection
conditional, very low evidence
Suggest evaluating lesions suspicious for focal nodular hyperplasia using multiphase MRI w/ hepatobiliary-specific contrast agents to distinguish focal nodular hyperplasia from hepatocellular adenoma
conditional, low evidence
Do NOT suggest routinely discontinuing OCPs in patients diagnosed w/ focal nodular hyperplasia
conditional, very low evidence
In patients w/ cirrhosis or chronic hepatitis B who meet criteria for hepatocellular carcinoma surveillance and have a suspected hemangioma, recommend continued imaging every 3-6 months for at least 1 year
strong, low evidence
In patients w/ asymptomatic simple hepatic cysts, regardless of size, recommend expectant management w/o need for routine surveillance or intervention
strong, low evidence
In patients w/ simple hepatic cysts w/ specific high-risk features seen on US (ie: septation, calcification, nodularity, heterogeneity, presence of daughter cysts, fenestrations), recommend further investigation w/ CT or MRI
strong, low evidence
Suggest surgical cyst fenestration or aspiration w/ sclerotherapy for management of patients w/ symptomatic simple hepatic cysts
conditional, low evidence
Suggest discontinuation of exogenous estrogen use in women w/ polycystic liver disease
conditional, very low evidence
For patients w/ PCLD with numerous small- to medium-sized cysts throughout the liver not amenable to surgical resection, cyst fenestration, or aspiration sclerotherapy, or for patients w/ symptomatic ADPKD w/ concurrent PCLD, recommend medical management using somatostatin analogs
strong, moderate evidence
Suggest surgical management in patients w/ complicated hydatid cysts (ie: communicating w/ the biliary tree, multiseptated, rupture, hemorrhage, secondary infxn) provided there is no contraindication to surgery
conditional, very low evidence
In patients w/ uncomplicated hydatid cysts in whom surgery is not an option, suggest percutaneous treatment w/ PAIR w/ adjunct antihelminthic therapy
conditional, low evidence
