Diagnosis of liver hemangioma

[123xyz]

Asian/M/high 40s

During a routine physical exam, the ultrasound technician found 3-4 echogenic and well circumferential masses at the right lobe of the liver.  The biggest one is about 4x4x4 cm in size at the posterior.  The technician indicated that additional diagnosis(such as CT scan) may be required, and asked me to speak to my personal physician.  My personal physician said they are liver hemangiomas, asked some questions regarding my medical history, and requested me to come back in three months for a follow-up ultrasound exam.  

However, a few days later, after I asked how certain these masses are actually liver hemangiomas, my personal physician referred me to a CT scan.  My questions are:

1) Is CT scan a preferred (or required) step in handling a case similar to mine?

2) CT scan has its inherited risk because it uses a much higher dosage of radiation when compared to a normal x-ray procedure.  Does the benefit of taking a CT scan exceed the risk in my case even though my personal physician did not recommend CT initially?

3) Since my personal physician did not recommend CT initially, and the main reason for the CT referral several days later was because I asked additional questions, should I go ahead to take the CT scan?

4) How effective is MRI in diagnosing liver hemangioma?  Although it may be more expensive, can I ask my personal physician to gave me an MRI referral instead?  

[Kevin Pho, MD]

To answer your questions:
1) CT or MRI is a more detailed study and is reasonable in this scenario.

2) Can't comment on that without reviewing your chart.  A single CT scan would be helpful in the diagnosis without imparting a significant exposure to radiation.

3) I would go ahead with the CT scan.

4) MRI is more detailed than a CT scan.  Some may go to the MRI directly - this decision is physician dependent.  It can certainly be discussed.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_

[SindyFed]

Three months after the birth of my son I started feeling pain under both rib cages, in my back near the liver and in my shoulder.  While trying to find the source of the pain they found a 1cm  Hepatic hemangioma.  My doctor said it is not likely the source of my pain.  Since then I have had every test you can think of and nothing else was found.  I am convinced that the hemangioma is the source of my pain.  I am going to have an mri and see if it has grown and if maybe they can remove it.  When I saw your entry it made me realize I am not going crazy this pain is real and this is likely the reason for it.  Thankyou

[SindyFed]

Three months after the birth of my son I started feeling pain under both rib cages, in my back near the liver and in my shoulder.  While trying to find the source of the pain they found a 1cm  Hepatic hemangioma.  My doctor said it is not likely the source of my pain.  Since then I have had every test you can think of and nothing else was found.  I am convinced that the hemangioma is the source of my pain.  I am going to have an mri and see if it has grown and if maybe they can remove it.  When I saw your entry it made me realize I am not going crazy this pain is real and this is likely the reason for it.  Thankyou