From the case:
Wheel within a wheel sign (diagram)
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This is one of several appearances of a lesion caused by hepatic candidiasis on ultrasound. The outer hypoechoic "wheel" corresponds to fibrosis, which surrounds a middle hyperechoic "wheel" of inflammation. The central hypoechoic focus represents an area of central necrosis.
Of note, this appearance is not reported by CT imaging.
Case Discussion
Author: Brian Gilcrease-Garcia