The tumor was so large that on initial US, diffuse liver disease, i.e. cirrhosis, was suspected. Contrast-enhanced ultrasound enabled targeted biopsy by delineating tumor well from normal liver, which was difficult on B-mode.  Without CEUS guidance, it is likely that multiple needle passes would have been required to achieve diagnostic material. Capsular retraction and hypoenhancement are features of cholangiocarcinoma.