Abdominal radiograph shows a left upper quadrant mass displacing the stomach. MR demonstrate a mass which is high in signal peripherally on T2, very low in signal centrally on T1, and enhances peripherally on post-Gd images. The mass arises from the left lobe of the liver.
The two most common lesions in the liver in childhood are hepatoblastoma and infantile hemangioendothelioma.
Both occur in young children and it is not always possible to differentiate between the two.
A clue in this patient (not told) is a low alpha fetoprotein.
Hepatoblastomas occur in patients usually under two years of age and may present with a mass, pain, weight loss or precocious puberty due to chorionic gonadotropin production by the tumor.
Infantile hemangioendothelioma occurs in children usually under 6 months of age and may be solitary or diffuse in the liver.
A clue may be heart failure due to increased flow.
Both may appear solid on ultrasound, contain calcium and undergo peripheral enhancement.
The hemangioendothelioma undergoes peripheral fill-in over time.
The other lesions that occurs in young children are mesenchymal hamartoma, which is central and based in the porta hepatis and sarcoma, which cannot be distinguished.
Biopsy is need for specific diagnosis of liver lesions in children.
Biopsy confirmed diagnosis and mass is decreasing in size being treated with steroid and interferon on follow up studies.