Hemangioma in hepatic steatosis (CEUS)

Typical B-mode US and CEUScontrast-enhanced ultrasound (CEUS) appearance of a small hemangioma in a steatotic liver affected by steatosis. The case also demonstrates the main advantage of CEUS, by allowing the examiner to follow the enhancement pattern in real time throughout all phases.

The liver shows diffuse hyperreflectivity with geographical areas low echogenicity in segment 5 adjacent to the gallbladder fossa - these are pathognomichighly specific for benign hepatic steatosis with associated focal fatty sparing.

A hypoechogenic, circumscribed solid lesion is also apparent in segment 2II of the left lobe, which was not visible inon prior imaging (CT and US/US). Due to the small size and ideal position of the lesion CEUScontrast-enhanced ultrasound (CEUS) was recommended for further evaluation instead of axialcross-sectional imaging, due to its superior temporal and spatial resolutionresolutions.

As with any other CEUS exam the lesion was first confirmed and measured and the entire liver was scanned using B-mode US.

After the injection of iv.IV contrast (SonoVue) the lesion demonstrated marked hyperenhancement during the entire arterial phase (see cine loop), while it remained isointense throughout the portal and sinusoidal phases. Most importantly no washout could be observed. Altogether the findings are characteristic for a flash filling-filling hemangioma, and do not support malignancy. Prior oncological control CT exams were performed with only venous phase acquisitions to limit radiation dose, which offers an explanation why the lesion remained undetected. Further regular follow-up of the patient is nevertheless warranted.

The geographical low echogenicity areas remained isointense through the entire exam (not shown) in line with focal fatty sparing.