Case of the Day: A Black Mass is found in the liver!!! CEUS to the rescue

Teaching Point:

This mass can easily be mistaken for a cyst due to the presence of posterior enhancement and significantly hypoechoic echogenicity. However, this lesion lacks a strong back wall characteristic of a cyst and shows both internal low-level echoes and color Doppler signal that are red flags for a solid mass. Since technical factors can lead to difficulty with differentiation, CEUS is an excellent tool to confirm the presence of any solid and vascular components.

Teaching Point:

This lesion shows Arterial Phase Hyperenhancement with Rapid washout seen in the movie clip. Because the patient does not have any known liver risk factors, LI-RADS does not apply in this case. Instead, the arterial phase hyperenhancement and rapid washout suggest a non-hepatocellular malignancy.

Teaching Point:

This Mass is shown after observation with CEUS for 3mins.  The Mass shows Marked/Strong washout.  In a liver with no risk-factors and a large black mass, with APHE and Rapid strong washout - consider Lymphoma.   This patient’s final diagnosis is Lymphoma.  (biopsy proven)