Differential diagnosis of pediatric liver mass

• Abscess
• Choledochal cyst
• Focal nodular hyperplasia
• Congenital hepatic hemangioma
• Hepatoblastoma
• Hepatocellular carcinoma
• Mesenchymal hamartoma
• Metastases

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