Case 4

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curated by Dr. Stephanie Wilson

September 6, 2021

NAFLD With no cirrhosis

48 y/o female

An unclear liver lesion is found and CEUS is recommended. What do you see?

Findings:

Surveillance revealed a liver mass that had increased in size from 1.4cm in 2018, to 4.5 cm in 2020.

She had no History of Birth Control use, and was sent to CEUS for further characterization of her liver mass.

What is your diagnosis?

Unenhanced Images

Greyscale image shows a large heterogeneous mass with a hypoechoic rim abutting the left portal vein

Color Doppler image shows distinct and prominent blood vessels centrally within the mass.

Choose your diagnosis:

Did your diagnosis change?

Enhanced Images

CEUS in the Arterial Phase (AP), from 0 to 11 seconds, shows avid enhancement within the mass with distinct centrifugal fill from the inside out.

CEUS in the Portal Venous Phase (PVP) at 5 mins suggests very weak washout.

Choose the final diagnosis:

Results

Diagnosis

Focal Nodular Hyperplasia (FNH) Benign Lesions are characterized by their distinct fill patterns in the Arterial Phase. Most benign lesions are found on surveillance ultrasound. CEUS can be done immediately, and it has exquisite spatial resolution making it outstanding for the visualization of the smallest of vessels especially with the early fill patterns of benign lesions. Although there may have been a suggestion of weak washout the fill pattern is unequivocal. The patient went on to more conservative management

An unclear liver lesion is found and CEUS is recommended. What do you see?

What is your diagnosis?

Results

Diagnosis

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