Hyperechoic liver lesions

Last revised by Matt A. Morgan on 27 Aug 2022

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.



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).

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 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. A "typical hemangioma" has been described as < 3 cm 6, although this distinction appears to have originally meant to distinguish between "typical" and "cavernous" hemangiomas.

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