Finding an unexpected large mass in the liver requires prompt careful investigation and management. Imaging plays a vital part in the patient's pathway but histological analysis remains the gold standard for accurate diagnosis and may prevent unnecessary surgical intervention. We report the incidental detection and subsequent management of a large intra-abdominal mass located directly adjacent to the left lobe of the liver. Imaging appearances were consistent with a necrotic metastasis or a fibrolamellar hepatocellular carcinoma (FLHCC), both of which carry a poor prognosis. However, tissue analysis from a core biopsy correlated with lymphangioma, thus affording conservative management. Both FLHCC and lymphangioma are rare tumours but the prognosis for these conditions is very different. We describe briefly the demographics and imaging features associated with each one.
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