Presentation
Referred for further evaluation after recent screening US identified a small hypoechogenic lesion in the left lobe of the steatotic liver.
Patient Data
Prior to administration of IV ultrasound contrast medium, a thorough B-mode US evaluation of the liver is performed again. In segment II of the diffusely hyperechoic, steatotic liver a 1.3 cm circumscribed hypoechoic solid lesion can be seen. Note is also made of the clearly benign geographic hypoechogenicity around the porta hepatis, characteristic of focal fat sparing.
- The time: 0:00 image taken prior to the administration of the contrast agent shows only artifacts in the CEUS view. Note that the artificially reconstructed B-mode-like image (right side) has significantly poorer image quality, but it serves no other purpose than to help keeping the lesion within the field of view during the exam.
- Following the administration of the contrast agent (SonoVue) the lesion shows profound and homogeneous early arterial phase hyperenhancement. This is best appreciated on the cineloop.
- In the portal venous and sinusoidal phases the lesion is still relatively hyperintense, showing retained enhancement compared to the adjacent liver parenchyma.
- The rest of the liver enhances homogeneously.
Case Discussion
The observed early hyperenhancement of the lesion, which was retained until the late phase is strongly indicative of a benign aetiology and is in line with a flash-filling haemangioma. The hypoechogenicity observed on the B-mode scan is seemingly atypical, but we have to keep in mind that the lesion was detected in a markedly hyperechogenic, diffusely steatotic liver.
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