Slow filling hepatic hemangioma (CEUS)

Case contributed by Dr Balint Botz

Presentation

Referred for further evaluation of an incidentally discovered hyperechogenic lesion in the left lobe of the liver. Asymptomatic.

Patient Data

Age: 40 years
Gender: Female
Ultrasound

1. Non-contrast US evaluation

A well-circumscribed slightly inhomogeneous, hyperechogenic lesion is visible in segment III of the left lobe, that shows no abnormal vascularity even when evaluated with MV-flow. The appearance makes hepatic hemangioma the most likely diagnosis, but the picture is far from pathognomonic, the CEUS is justified. 

Ultrasound

2. CEUS (SonoVue)

  • The cine recording begins when the first microbubbles arrive in the field of view. Throughout the arterial phase the lesion shows only minimal enhancement along its margins, most of it shows no contrast uptake. 
  • The bulk of the lesion remains unenhancing throughout the sinusoidal (T 02:09) and late phase (T 04:00) 
  • Altogether the findings are in line with the diagnosis of slow filling hemangioma and do not support a malignant etiology. 

Case Discussion

Typical CEUS appearance of slow filling hepatic hemangioma. 

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Case information

rID: 66057
Published: 3rd Feb 2019
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: University of Pécs

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