Incidental Findings in Pediatric Patients: How to Manage Liver Incidentaloma in Pediatric Patients

Abstract

The World Federation for Ultrasound in Medicine and Biology (WFUMB) is addressing the issue of incidental findings (IFs) with a series of publications entitled “Incidental imaging findings—the role of ultrasound”. IFs in the liver of newborns and children are rare and much less commonly encountered than in adults; as a result, they are relatively much more frequently malignant and life-threatening, even when they are of benign histology. Conventional B-mode ultrasound is the well-established first line imaging modality for the assessment of liver pathology in pediatric patients. US technological advances, resulting in image quality improvement, contrast-enhanced ultrasound (CEUS), liver elastography and quantification tools for steatosis have expanded the use of ultrasound technology in daily practice. The following overview is intended to illustrate incidentally detected liver pathology covering all pediatric ages. It aims to aid the examiner in establishing the final diagnosis. Management of incidentally detected focal liver lesions (FLL) needs to take into account the diagnostic accuracy of each imaging modality, the patient’s safety issues (including ionizing radiation and nephrotoxic contrast agents), the delay in diagnosis, the psychological burden on the patient and the cost for the healthcare system. Moreover, this paper should help the pediatric clinician and ultrasound practitioner to decide which pathologies need no further investigation, which ones require interval imaging and which cases require further and immediate diagnostic procedures.

Pediatric Hepatocellular Adenomas: What Is Known and What Is New?

“…A bi-allelic mutation of the APC gene will disrupt this function leading to accumulation and activation of beta-catenin mimicking beta-catenin mutated adenomas. Although bi-allelic mutations of APC have been reported in HCAs arising in FAP [44], that is not necessarily true with one report of bi-allelic HNF1A mutations in a HCA arising in a patient with FAP [45,46]. Both are reports from adults and there are no data on the spectrum of somatic mutations or consensus on management strategies for FAP-related pediatric HCAs.…”