Presentation
Prior Billroth II gastric resection due to signet ring cell cancer more than a decade age. Follow-up.
Patient Data
Age: 80 years
Gender: Male
From the case:
Hypervascular liver metastasis of gastric cancer (CEUS)
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Noncontrast scan due to contrast agent adverse reaction previously.
Ill-defined hypodense lesion in the segment 5, new compared to prior exam. The lesion is concerning for malignancy.
- Status post Billroth II resection.
- Stable expansile lytic area in the left ilium and known L5 vertebral hemangioma.
From the case:
Hypervascular liver metastasis of gastric cancer (CEUS)
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- The lesion appears much larger on B-mode US in the steatotic liver, and is surrounded by an ill-defined geographic area of hypoechogenicity.
- Following contrast (SonoVue) administration the enhancement of the lesion is only marginally increased compared to the normal liver tissue in the arterial phase.
- Washout begins to develop in the late arterial phase, and gets gradually more pronounced.
Case Discussion
CEUS is an excellent choice to further interrogate liver lesions in patients who cannot receive CT contrast agents. Arterial phase enhancement pattern of metastases is variable, and not always easy to assess, however the washout provides clear evidence of the malignancy.
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