The differential diagnosis of solid liver lesions is broad, but many can be diagnosed noninvasively. In some cases, predominantly solid liver lesions may have cystic components, as may be seen with hemangiomas or tumors that have areas that are necrotic. Conversely, predominantly cystic liver lesions may have solid areas, particularly in the setting malignancy.
This topic will review the differential diagnosis of solid liver lesions, outline an approach to their evaluation, and discuss the radiographic findings associated with common solid liver lesions. The pathology of malignant liver tumors, the approach to patients with cystic liver lesions, and liver abscesses are discussed elsewhere. (See "Diagnosis and management of cystic lesions of the liver" and "Pyogenic liver abscess" and "Extraintestinal Entamoeba histolytica amebiasis", section on 'Amebic liver abscess'.)
There are numerous causes of solid liver lesions, both benign and malignant. It is important to establish a correct diagnosis, especially when the potential for therapy exists. The diagnosis requires consideration of the clinical history, risk factors, laboratory test findings, imaging studies, and in some cases, pathologic examination of the lesion. (See 'Diagnostic approach' below.)
While most of these lesions present as solitary masses, multiple lesions may be seen in patients with hepatic hemangiomas, idiopathic noncirrhotic portal hypertension, regenerative nodules, hepatocellular carcinoma, and metastatic disease.
Common benign liver lesions include :