Differential diagnosis of pediatric liver mass

Approach to the differential diagnosis of liver mass:

  • In the neonate, a solid liver mass could be congenital hepatic hemangioma (fine / granular calcification, enhances peripherally more than the liver) or hepatoblastoma (coarse / chunky calcification, enhances irregularly and less than the liver)
  • In the older child, a solid liver mass could be focal nodular hyperplasia or hepatocellular carcinoma
  • Cystic liver masses include choledochal cyst (which communicates with the biliary tree), mesenchymal hamartoma (which does not have calcifications or enhancement), and abscess (which often has a thick enhancing rim)
  • Multiple liver masses could be pyogenic abscesses (look for the cluster sign of small pyogenic abscesses coalescing into a larger cavity), microabscesses from fungal disease, or metastases from neuroblastoma or Wilms tumor or lymphoma
  • AFP as a tumor marker is elevated in hepatoblastoma, hepatocellular carcinoma, and hepatic infantile hemangioma and can also be normally elevated in neonate