Liver mass echocardiography and ultrasound

Liver Mass Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differential Diagnosis
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
Evaluation of Liver Mass
Staging
History and Symptoms
Physical Examination
Laboratory Studies
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Case Studies
Case #1
Liver mass echocardiography and ultrasound On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Liver mass echocardiography and ultrasound All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Liver mass echocardiography and ultrasound
CDC on Liver mass echocardiography and ultrasound
Liver mass echocardiography and ultrasound in the news
Blogs on Liver mass echocardiography and ultrasound
Directions to Hospitals Treating bone or soft tissue mass
Risk calculators and risk factors for Liver mass echocardiography and ultrasound

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Ultrasound is the initial method of choice for the evaluation of liver mass. On ultrasound, characteristic findings of liver mass, may include: fluid-filled spaces without clear walls, posterior acoustic enhancement, anechoic, hypohechoic, or hyperechoic lesions. The evaluation of liver mass will mainly depend on the echogenecity. Further evaluation with ultrasound should include Doppler examination to determine vascular pattern.

Ultrasound

Ultrasound is the initial method of choice for the evaluation of liver mass. The evaluation of liver mass will mainly depend on echogenecity

• On ultrasound, characteristic findings of liver mass, may include:
  • Fuid-filled spaces without clear walls
  • Posterior acoustic enhancement
  • Anechoic, hypohechoic, or hyperechoic lesions

Types:

Evaluation with ultrasound should include the following techniques

• Doppler examination
• Contrast-enhanced ultrasound

	Ultrasound	Enhanced ultrasound
Benign liver mass	Homogeneous hyperechogenicity Hypoechogenicity with hyperechoic rind Posterior sonic enhancement	Wash out during portal venous phase regardless of arterial vascularity
Malignant liver mass	Hypoechoic halo Target appearance	No wash-out during portal phase
Central scar: large central artery is usually present with spoke-wheel like centrifugal flow Sonographic halo sign: hypoechoic halo sign in liver metastases: used in hepatobiliary imaging, is a concerning feature for malignant lesion if the lesion is a hyperechoic liver lesion

The table below summarizes the characteristic ultrasound findings of common benign and malignant liver masses.

Ultrasound findings of common liver masses
Common liver masses	Ultrasound finding
Hepatic hemangioma	Well-demarcated Homogeneous Hyperechoic mass May be hypoechoic in patients with fatty infiltration
Focal nodular hyperplasia	Detectable lesions Central scar with displacement of peripheral vasculature (Doppler examination)
Hepatic adenoma	Large Right lobe of the liver Central hypoechoic region
Idiopathic noncirrhotic portal hypertension	Isoechoic lesions
Hepatocellular carcinoma	Poorly-defined margins Coarse, irregular internal echoes
Cholangiocarcinoma	Hypo-, iso-, or hyperechoic Homogenous or heterogenous
Metastases	Metastases from adenocarcinoma Multiple and hypoechoic in comparison with the surrounding liver parenchyma

Central scar: This image shows the presence of focal nodular hyperplasia. Detectable lesions characteristically will demonstrate a central scar with displacement of peripheral vasculature on color Doppler examination

Sonographic halo sign: hypoechoic halo sign in liver metastases: used in hepatobiliary imaging, is a concerning feature for malignant lesion if the lesion is a hyperechoic liver lesion