curated by Dr Dirk Clevert
February 14, 2022

In the pre-existing liver cirrhosis, the baseline B-mode examination demarcates a heterogenic liver lesion, measuring 5.5 x 5.1 cm

The lesion shows no internal signal flow in the color Doppler and power Doppler examination.

Following the intravenous administration of contrast agent, the lesion demonstrated peripheral nodular enhancement, progressing in a centripetal direction, areas of thrombosis and no washout during the entire examination

63-y/o male patient with clinical background of cirrhosis and ascites is referred to our department for a sonographic liver staging.

An unclear liver lesion is found. In order to get more information, CEUS is performed. What do you see?

Findings:

The typical CEUS feature of a hemangioma is peripheral, discontinuous nodular (syn.: globular) enhancement in the arterial phase with progressive centripetal partial or complete fill-in.

Complete fill-in occurs only in 40–50 % cases during the late phase. This filling-in is often faster in smaller lesions and the entire lesion may be hyperenhancing in the arterial phase

What is your diagnosis?

Unenhanced Images

Choose your diagnosis:

Did your diagnosis change?
Enhanced Images

Choose the final diagnosis:

Results

Case6_before Case6_after

Diagnosis

CEUS is indicated when a definitive diagnosis of a hemangioma cannot be achieved using conventional US, as the addition of CEUS markedly improves the diagnostic accuracy in 90–95 % of the cases.

Overall sensitivity of CEUS for diagnosis of haemangioma is 86 % (95 %CI: 81–92 %).

CEUS is recommended for the characterization of focal liver lesions in the non-cirrhotic liver in patients with inconclusive findings at CT or MR imaging

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