Table of contents

Focal nodular hyperplasia


Key sources

The following summarized guidelines for the evaluation and management of focal nodular hyperplasia are prepared by our editorial team based on guidelines from the European Association for the Study of the Liver (EASL 2023,2016), the American College of Radiology (ACR 2020), the European Federation of Societies for Ultrasound (EFSU 2020), and the American College of Gastroenterology (ACG 2016,2014). ...
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Diagnostic investigations

Contrast-enhanced ultrasound
As per ACR 2020 guidelines:
Obtain contrast-enhanced abdominal ultrasound of an indeterminate > 1 cm liver lesion on initial ultrasound in patients with a normal liver with no suspicion or evidence of extrahepatic malignancy or underlying liver disease.
Obtain contrast-enhanced abdominal ultrasound of an incidental liver lesion > 1 cm on initial ultrasound, non-contrast or single-phase CT, or non-contrast MRI in patients with known chronic liver disease.
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  • Cross-sectional imaging

Diagnostic procedures

Liver biopsy: as per ACG 2014 guidelines, do not perform a routine liver biopsy to confirm the diagnosis of FNH.

Medical management

Indications for treatment: as per EASL 2016 guidelines, do not offer treatment in patients with FNH.

Specific circumstances

Pregnant patients
As per EASL 2023 guidelines:
Advise female patients with FNH that pregnancy is not contraindicated and vaginal delivery is not associated with increased risks.
Do not obtain routine imaging to monitor FNH during pregnancy.

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  • Patients with HHT

  • Patients on oral contraceptives

Patient education

General counseling: as per ACG 2014 guidelines, counsel patients that pregnancy and the use of oral contraceptives or anabolic steroids are not contraindicated in FNH.

Follow-up and surveillance

Indications for referral: as per EASL 2016 guidelines, refer patients with atypical imaging findings or in the presence of symptoms to a benign liver tumor multidisciplinary team.

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  • Serial imaging assessment