Presentation
Abnormal liver function tests.
Patient Data
Solitary hypoechoic lesion with adjacent Doppler signal.
Increased echogenicity of the liver compared to the right kidney in keeping with diffuse hepatic steatosis.
Liver segment 5/8 hypodense lesion that demonstrates peripheral arterial phase enhancement with centripetal filling on portal venous phase and is isodense to liver and blood pool on the delayed phase.
Slightly superiorly to this lesion in liver segment 7 is a peripheral area of arterial enhancement without corresponding abnormality on the other phases - this is most likely a THAD.
Case Discussion
The CT findings are typical of hemangioma, however, the ultrasound findings are not. When a focal hepatic lesion is identified the most important initial assessment is the background liver parenchyma (e.g. fatty infiltration, cirrhosis) as this will affect the appearance of the lesion. In this case, the diffuse fatty infiltration increases the background echogenicity of the liver making the normally hyperechoic hemangioma appear hypoechoic.