["Ultrasonographically detected liver lesion"--how to proceed?]

Focal liver lesions found incidentally in ultrasound are predominantly uncomplicated cysts, cavernous hemangiomas or typical metastases. In most of these cases a reliable diagnosis can be made. Atypical findings, however, always are suspicious being malignant. In this particular situation imaging methods, such as CT, NMR or scintigraphy, should be applied. Despite of this a final diagnosis may not be found in all cases. An ultrasound-guided fine-needle biopsy is then required. Biopsy during laparotomy might be the procedure of choice in some situations.