I have a male patient who initially presented with an umbilical hernia and acid reflux/pressure-type symptoms in the abdomen. Symptoms improved but he still decided on a hernia repair around the umbilicus. Symptoms continued to improve but then returned months later and ended up in the ER with a dx of small bowel obstruction. At this time, they did a CT scan and found 4 'peripherally enhancing lesions compatible with multiple liver hemangiomas' with the largest being 4.3 x 4.8 cm. His initial listening after the ER visit was thorax, and balancing which reduced the pressure/reflux symptoms he's having. During the more recent visit (I hadn't had the CT scan results yet or knowledge of the hemangiomas) his listening was posterior liver, diaphragm and portal vein. I was unable to do a seated liver lift due to abdominal tension, I was able to do some work from a seated anterior and supine approach. Now after seeing the CT results I can maybe see why I was unable to get in due to the hemangiomas? Can these be worked on? And since the ER didn't mention these as a concern, do I need to have a discussion with the patient about their ability to continue to add pressure around this area of his body, including the gastroesophageal area? Thank you.