Most focal nodular hyperplasia (FNH) lesions are incidentally discovered and not the direct cause of symptoms. When abdominal pain is present alongside confirmed FNH, the clinical question centres on whether the lesion is truly symptomatic and which interventions are appropriate given the patient's overall situation.
This protocol applies to patients with focal nodular hyperplasia who present with symptoms such as abdominal pain. Surgical resection may be considered in rare symptomatic cases; however, patients should understand that symptoms may not resolve after surgery, as FNH is often incidental rather than the cause of pain. When surgery is not feasible due to comorbidities or anatomic factors, a catheter-based approach may be an appropriate alternative.
When surgery is not an option, a minimally invasive, catheter-based embolization technique targeting the lesion's vasculature may be considered — with or without an adjunctive agent. The full algorithm, selection criteria, and procedural details are available in the complete protocol.
The primary objective is a meaningful reduction in lesion size. Case series have reported size reductions of up to 50% with certain embolization approaches, though outcomes vary.
DOI: 10.14309/ajg.0000000000002857