Question

A 22 year old man presents with a solitary 2 cm space occupying lesion of mixed echogenicity in the right lobe of the liver on ultrasound. The rest of the liver is normal. Which of the following tests should be done?

• A. Ultrasound guided biopsy of the lesion
• B. Hepatic scintigraphy
• C. Hepatic angiography
• D. Contrast enhanced CT scan of the liver

Hint:

A young patient with a solitary liver mass in an otherwise normal liver needs non-invasive characterization by contrast CT before any biopsy is considered.

Answer 1

The Correct Option is D

Step 1: Understand what the finding means.
A young man with a single small mass in an otherwise normal liver most often has a benign lesion such as a hemangioma, focal nodular hyperplasia, or a hepatic adenoma. Ultrasound alone cannot tell these apart with confidence because they can all look like a mixed echogenicity mass.

Step 2: Decide the next step in the work up.
The next step should give clear information about blood supply and internal structure without touching the lesion. A contrast enhanced CT scan does this well, showing the enhancement pattern that separates a hemangioma, focal nodular hyperplasia, and an adenoma from each other and from a malignant lesion.

Step 3: Explain why a biopsy is not the first step.
Many benign liver lesions, especially hemangiomas and adenomas, are highly vascular. A needle biopsy through them risks serious bleeding, and if the lesion turns out to be a well vascularized benign tumor, the risk outweighs the benefit. Biopsy is used later only if imaging leaves the diagnosis unclear.

Step 4: Explain why hepatic scintigraphy is not the best choice.
Scintigraphy can support a diagnosis of focal nodular hyperplasia by showing uptake of the tracer, but it gives far less detail overall than CT and is not the standard first test today.

Step 5: Explain why hepatic angiography is not the best choice.
Angiography is an invasive test that maps blood vessels directly. It used to help diagnose vascular liver lesions, but contrast enhanced CT now gives similar and often better information without an invasive procedure, so angiography is not the first line test.

Step 6: Final answer.
A contrast enhanced CT scan of the liver is the correct next test for this patient.
\[ \boxed{\text{Contrast enhanced CT scan of the liver}} \]