Benign liver lesions

Benign liver lesions are common and can pose a diagnostic challenge due to the difficulty in differentiating them from malignant hepatic lesions. They seldom present as an emergency. They are usually asymptomatic and are frequently detected incidentally during investigations for other conditions. Symptomatic lesions usually cause non-specific symptoms. Liver function tests are usually within the normal range, and diagnosis is established by abdominal ultrasound, computed tomography, magnetic resonance imaging or positron emission tomography. Further diagnostic modalities may include hepatic angiography and diagnostic laparoscopy with intraoperative ultrasonography. Biopsy or aspiration in the diagnosis of benign disease of the liver needs careful thought and multidisciplinary discussion and is contraindicated in certain scenarios due to the risk of bleeding and tumour seeding. Management strategies may vary from simple reassurance, lifestyle advice and observation through surveillance imaging, to complex hepatic resections or liver transplantation. Awareness of the natural history, clinical presentation and management strategies will ensure appropriate initial diagnostic work-up and prompt referral to a specialist hepatobiliary unit.