Centrifugal enhancement in a liver lesion

Case contributed by Dr Jan Frank Gerstenmaier

Presentation

A liver lesion was incidentally detected in this patient during a recent pelvic ultrasound (when the kidneys were assessed). There was no history of liver disease. No oral contraceptive use.

Patient Data

Age: 30
Gender: Female

B-mode ultrasound

Modality: Ultrasound

There is  a 1.35cm sharply circumscribed rounded lesion in segment VI of the liver. The lesion has a hypoechoic rim. No colour dopper signal was detected within. Surrounding liver parenchyma is normal in appearance. 

Contrast-enhanced ultrasound

Modality: Ultrasound

Timer in top right corner of the images.

Dynamic images demonstrate avid arterial enhancement commencing approximately 11s post injection of contrast. The first 4-5s of the clip clearly show a centrifugal, i.e. 'inside-out' pattern of enhancement. Select still images show equilibrium with liver parenchyma; there is no washout. The lesion is more difficult to see on the control B-mode image on the right hand side during portal venous phase because microbubbles present within the vascular spaces of the lesion are also visible on B-mode.

Case Discussion

Centrifugal enhancement in a liver lesion is most commonly seen in focal nodular hyperplasia, and this pattern is a good predictor of these lesions at contrast-enhanced ultrasound1. However, centrifugal enhancement can be an atypical feature of liver haemangiomas2 (the more commonly seen pattern in haemangiomas is centripetal).

In this case, centrifugal enhancement can be observed in a lesion as small as 1.4cm. The likely diagnosis is FNH, although the imaging is not diagnostic. There are no features to suggest a malignant process. This patient will be followed up with B-mode ultrasound to ensure stability.

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Case Information

rID: 21641
Case created: 6th Feb 2013
Last edited: 24th Feb 2016
Inclusion in quiz mode: Included

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