Laparoscopy in the management of antenatally detected liver masses

Antenatally detected liver masses that are not clearly benign on postnatal investigation pose a management dilemma. Unless the diagnosis is clear, observation alone is risky. Improvements in radiological diagnosis permit confirmation of the benign nature of these masses in some instances, but it is usually difficult to distinguish them from malignant lesions. Since recent advances in ultrasound facilitate identification of liver masses during prenatal life, differential diagnosis of these masses has become a recurring issue in recent years. Laparoscopy may play a major role in the surgical management of right upper quadrant masses detected antenatally. We describe its use in a patient with an antenatally detected liver mass. No clear diagnosis could be made with radiologic investigation in the neonatal period. Definitive diagnosis was made laparoscopically: focal nodular hyperplasia was confirmed with laparoscopy and biopsy. In cases where the etiology of a liver mass remains unclear after radiologic investigation, laparoscopic intervention may prove beneficial in neonates and infants. We present an algorithm for the management of similar antenatally detected right upper quadrant lesions.