A hyperechoic liver lesion on ultrasound can arise from a number of entities, both benign and malignant. A benign hepatic hemangioma is the most common entity encountered, but in patients with atypical findings or risk for malignancy, other entities must be considered.
- hepatic hemangioma: commonest hyperechoic liver lesion by far (present in 4% of the population) 1,4
- focal nodular hyperplasia
- hepatic adenoma with high fat content
- focal fatty change: focal hepatic steatosis
- inflammatory pseudotumor of the liver
- hepatic metastases
- hepatocellular carcinoma: particularly in a cirrhotic liver 3
The presence of hyperechogenicity can be a result of fat within a liver lesion 2, although some non-fat-containing lesions may also be echogenic (e.g. hepatic hemangioma).
- hypoechoic halo sign: considered a feature suggestive of malignancy
Some suggest pulse inversion harmonic imaging with quantitative evaluation as being useful in facilitating the differential diagnosis of hyperechoic focal liver lesions, where a lesion-liver ratio of ≥1 being predictive of a benign nature, assuming that malignant lesions show a ratio of <1 1.
If a single, well-defined, homogeneous, echogenic mass <3 cm is found in an asymptomatic patient, without a history of malignancy and without risk factors for liver tumors, then a diagnosis of hemangioma can be made on ultrasound without the need for another test 5. If an appropriate clinical history is not available, then a wider differential is appropriate.
- 1. Celik H, Ozdemir H, Yücel C et-al. Characterization of hyperechoic focal liver lesions: quantitative evaluation with pulse inversion harmonic imaging in the late phase of levovist. J Ultrasound Med. 2005;24 (1): 39-47. J Ultrasound Med (full text) - Pubmed citation
- 2. Basaran C, Karcaaltincaba M, Akata D et-al. Fat-containing lesions of the liver: cross-sectional imaging findings with emphasis on MRI. AJR Am J Roentgenol. 2005;184 (4): 1103-10. AJR Am J Roentgenol (full text) - Pubmed citation
- 3. Caturelli E, Pompili M, Bartolucci F et-al. Hemangioma-like lesions in chronic liver disease: diagnostic evaluation in patients. Radiology. 2001;220 (2): 337-42. Radiology (full text) - Pubmed citation
- 4. Pen JH, Pelckmans PA, Van maercke YM et-al. Clinical significance of focal echogenic liver lesions. Gastrointest Radiol. 1986;11 (1): 61-6. doi:10.1007/BF02035034 - Pubmed citation
- 5. Leifer DM, Middleton WD, Teefey SA et-al. Follow-up of patients at low risk for hepatic malignancy with a characteristic hemangioma at US. Radiology. 2000;214 (1): 167-72. doi:10.1148/radiology.214.1.r00ja09167 - Pubmed citation