DEAR DR. ROACH:
I am a 64-year-old man who had an ultrasound six months ago that revealed a 1.9-cm echogenic nodule in the right lobe of my liver. The radiologist felt it was a hemangioma. I recently had another ultrasound to determine if the nodule had changed, and thankfully, it has remained the same. A separate radiologist reviewing the current ultrasound also noticed two subcentimeter hepatic cysts on the right lobe of my liver.
So, I have two questions: Are the cysts a reason for concern? And why do radiologists often differ in their interpretations of viewings? This has happened before, where one radiologist didn’t report an issue that another radiologist did in a subsequent report of the same part of the body. — M.S.
ANSWER:
A hemangioma is a benign tumor of blood vessels that are commonly found in the liver. Women are more likely than men to have them, and they are most often diagnosed between the ages of 30 to 50. As many as 20% of people will have them, if you look carefully enough.
When a person gets an ultrasound for some other reason, it is common to find unexpected abnormalities (these sometime go by the name of “incidentalomas”), and the ordering physician must decide whether the abnormality needs to be evaluated. It’s occasionally the case that a person gets saved from a terrible outcome when cancer is found this way and removed before it could spread.
It is much more likely, however, that the person would have lived their entire life never knowing that they had this incidental abnormality. The vast majority of them do not need further evaluation, although sometimes a follow-up scan is ordered in the next six to 12 months to make sure the lesion is not growing like cancer would.
A hemangioma is an example of a solid mass. A fluid-filled mass (a cyst, by definition, is fluid-filled) in the liver is rarely a cause for concern. In a person with no symptoms in whom the cyst was found incidentally, no further evaluation is recommended for small…
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