Hepatic incidentaloma: a modern problem

As clinical skills give way to increased reliance on organ imaging, a new clinical problem is identified--the hepatic "incidentaloma." This may be defined as an unexpected solid filling defect in the liver of a well patient. Thirty-six such lesions have been seen in one practice over a period of 36 months. Twenty-nine (81%) were benign: 24 (67%) nonneoplastic conditions 5 (14%) benign tumors. The remaining 7 (19%) were malignant: 5 secondary tumors and 2 primary tumors. Patients with physical signs of liver mass or enlargement were more likely to harbor malignancies. An elevated serum alkaline phosphatase (SAP) was suggestive of malignancy. Hepatic hemangioma was the most common single diagnosis (20 patients, 56%). We propose a regimen of investigation which should allow diagnosis to be reached in about one-half of these patients without admission to the hospital. The rest will need at least a short hospital admission for angiography and fine-needle aspiration biopsy.