Presentation
Young patient in ICU with end-stage dilated cardiomyopathy referred for evaluation of persistent fevers.
A CT of the abdomen was performed in this patient as part of his evaluation for fever of unknown origin. The finding of a 5 cm low density segment VI lesion (55 HU) raised the suspicion of a hepatic abscess.
Further evaluation with ultrasound demonstrates a homogeneously echogenic lesion.
Administration of sonographic contrast demonstrates the typical features of a hemangioma that usually require a multiphase CT: early peripheral nodular enhancement, centripetal filling and persistent enhancement on delayed images (note the subtle echogenicity of the mass relative to liver at 5:34 min). Note, the number in the right upper corner indicates time post contrast administration, e.g. C5:34 means 5 minutes 34 seconds post contrast.
Case Discussion
Contrast-enhanced ultrasound (CEUS) is becoming a more common method of evaluating liver and renal masses. It has the advantages of dynamic interrogation of the mass, non-ionizing radiation and the contrast can typically be used in renal failure patients.