Hyperechoic liver lesions

A hyperechoic liver lesion on ultrasound can arise from a number of entities, both benign and malignant. A benign hepatic haemangioma is the most common entity encountered, but in patients with atypical findings or a risk for malignancy, other entities must be considered.


The presence of hyperechogencity can be a result of fat within a liver lesion 2 although some non-fat-containing lesions may also be echogenic (e.g. hepatic haemangiona) .

Radiographic features


Some suggest pulse inversion harmonic imaging with quantitative evaluation as being a useful in facilitating the differential diagnosis of hyperechoic focal liver lesions, where a lesion-liver ratio equal to or greater than 1 being predictive of a benign nature, assuming that malignant lesions show a ratio of less than 1 1.

Practical points

If a single, well-defined, homogeneous, echogenic mass <3 cm is found in an asymptomatic patient, without history of malignancy or without risk factors for liver tumours, then a diagnosis of haemangioma can be made on ultrasound without need for another test 5. If the appropriate clinical history is not available, then a wider differential is appropriate.

See also

Ultrasound - general index

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