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

SIMPLE SUMMARY: The World Federation for Ultrasound in Medicine and Biology (WFUMB) has recently launched a project on incidental findings (IF). Incidental findings of almost all organs are common and the topic is, therefore, of importance. This is a new concept of papers following a strictly defined structure and including the following headings: prevalence, epidemiology, clinical significance, clinical scenarios and the role of ultrasound and other imaging methods, summary statements and management strategies. The organs so far discussed in published papers are the adrenal glands, scrotum, salivary glands, spleen, female pelvis, biliary tree and, additionally, the important topic of managing incidental findings reported by medical students performing educational ultrasound examinations. The current paper summarizes IF of the liver in pediatric patients with special attention to the use of radiation-free ultrasound and contrast-enhanced ultrasound (CEUS). 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.