Subcapsular Lesions: Definition, Types, Imaging, and Management
Definition
A subcapsular lesion is a focal abnormality located just beneath the fibrous capsule of an organ (liver, kidney, spleen, lymph node). The capsule is a thin connective tissue layer enveloping the organ.
Common Sites and Etiologies
| Organ | Benign | Malignant |
|---|---|---|
| Liver | Hemangioma, cyst, FNH, adenoma | HCC, metastasis |
| Kidney | Simple cyst, angiomyolipoma | RCC, metastasis |
| Spleen | Cyst, hemangioma, hamartoma | Lymphoma, metastasis |
| Lymph node | Reactive hyperplasia | Metastasis, lymphoma |
Imaging Detection
- US: initial screening; characterizes cystic vs. solid.
- CT/MRI: enhancement patterns, fat content (AML), vascularity.
- PET-CT: metabolic activity for malignancy staging.
Biopsy Indications
- Indeterminate imaging, high suspicion for malignancy, need for histologic subtyping.
- Percutaneous (US/CT-guided) or laparoscopic.
Management
- Benign, asymptomatic: surveillance imaging.
- Benign, symptomatic/large: ablation, resection, embolization.
- Malignant: organ-specific oncology protocols (resection, ablation, systemic therapy, transplant).
Multidisciplinary review (radiology, hepatology/nephrology/splenology, oncology, surgery) optimizes decisions.
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