Initial Laboratory and Imaging Workup for Hepatomegaly on CT Abdomen

Essential Laboratory Tests

The National Comprehensive Cancer Network recommends ordering a comprehensive hepatic function panel including AST, ALT, alkaline phosphatase, bilirubin, albumin, PT/INR, and CBC, along with hepatitis B and C serologies, to assess liver synthetic function and identify the underlying etiology of hepatomegaly 1, 2
Liver enzymes, such as AST, ALT, alkaline phosphatase, and lactate dehydrogenase, should be measured to distinguish between hepatocellular injury and cholestatic patterns 1, 2
Synthetic function markers, including albumin, total protein, and PT/INR, are critical for assessing hepatic reserve and distinguishing acute from chronic liver disease 1, 2
A complete blood count (CBC) helps identify thrombocytopenia and anemia, suggesting portal hypertension or chronic disease 1
Viral hepatitis serologies, such as hepatitis B surface antigen (HBsAg) and hepatitis C antibody, should be tested as viral hepatitis is a major cause of hepatomegaly and chronic liver disease 1, 2
Renal function, including BUN and creatinine, is essential for Child-Pugh scoring and provides prognostic information in liver disease 1

The American College of Radiology recommends multiphase contrast-enhanced CT or MRI if focal liver lesions are identified, particularly in patients with chronic liver disease or risk factors for hepatocellular carcinoma 5, 6
For lesions >1 cm in patients with chronic liver disease, either multiphase CT or MRI with contrast are equivalent alternatives per ACR guidelines 5, 6
Abdominal ultrasound is indicated if the initial CT was non-contrast or single-phase, as it effectively detects biliary dilatation, gallstones, and signs of cirrhosis with 65-95% sensitivity 3, 4

The National Comprehensive Cancer Network recommends calculating the Child-Pugh score using albumin, bilirubin, PT/INR, and clinical assessment of ascites and encephalopathy to classify patients as compensated (Class A) versus decompensated (Class B/C) cirrhosis 1
The Child-Pugh score guides prognosis and treatment decisions, particularly for patients being considered for hepatocellular carcinoma treatment 1