Hepatic Cyst
Hepatic cysts are the most frequently encountered liver
lesion overall .Cystic lesions of the liver can arise
primarily (congenital) .Secondarily from trauma (seroma
or biloma), infection (pyogenic or parasitic), or neoplastic
disease. Congenital cysts are usually simple cysts
containing thin serous fluid occur in 5 to 14% of the
population, with higher prevalence in women. In most
cases, congenital cysts are differentiated from secondary
cysts (infectious or neoplastic origin) in that they have no
visible wall or solid component and are filled with
homogeneous, clear fluid. For benign solid liver lesions,
the differential diagnosis includes hemangioma,
adenoma, focal nodular hyperplasia, and bile duct
hamartoma
Benign liver tumours
Haemangiomas
These are the most common liver lesions. They consist of an
abnormal plexus of vessels,
and their nature is usually apparent on ultrasound. If diagnostic
uncertainty exists, CT scanning with delayed contrast
enhancement
shows the characteristic appearance of slow contrast
enhancement due to small vessel uptake in the haemangioma.
Often, haemangiomas are multiple. Lesions found incidentally
require confirmation of their nature and no further treatment.
The management of ‘giant’ haemangiomas is resection for the
large lesions, especially if they appear to be symptomatic
Pyogenic liver abscess
The aetiology of a pyogenic liver abscess is unexplained in the
majority of patients. It has an increased incidence in the elderly,
diabetics and the immunosuppressed, who usually present
with anorexia, fever and malaise, accompanied by right upper
quadrant discomfort. The diagnosis is suggested by the finding of
a multiloculated cystic mass on ultrasound or CT scan and is confirmed by
aspiration for culture and sensitivity.
The most common organisms are Streptococcus milleri and
Escherichia coli
Treatment is with antibiotics and ultrasound-guided aspiration.
First-line antibiotics to be used are a penicillin, aminoglycoside
and metronidazole or a cephalosporin and metronidazole. Often,
repeated aspirations may be necessary . A source for
the liver abscess should be sought, particularly from the colon.
Hepatocellular carcinoma
Primary liver cancer (HCC) is one of the world’s most common
cancers, Many patients with chronic liver disease are screened for the
development of HCC by serial ultrasound scans of the liver or
serum measurements of alpha-fetoprotein (AFP). Patients often
present in middle age, either because of the symptoms of chronic
liver disease (malaise, weakness, jaundice, ascites, variceal
bleed, encephalopathy) or with the anorexia and weight loss
of an advanced cancer. The surgical treatment options include
resection of the tumour or liver transplantation. depending on the
stage of the underlying liver disease, the size and site of the
tumour, the availability of organ transplantation and the management
of the immunosuppressed patient .Patients with unresectable
disease can be offered local ablative treatments, such as transarterial embolisation
(TAE), transarterial chemoembolisation (TACE), percutaneous ethanol ablation
(PEA).These local ablative treatments may also be used as
bridging procedures to liver transplantation.