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

Teaching Point:

This mass can easily be interpreted as a cyst due to the presence of posterior enhancement and an extremely hypoechoic echogenicity. The mass appears “black”. However, this lesion lacks a strong back wall characteristic of a cyst and shows both internal low-level echoes. Since technical factors can lead to difficulty with differentiation between a cystic and solid mass. CEUS is an excellent tool to confirm the presence of any solid and/or vascular components.

Teaching Point:

Demonstration of vascular signals inside a very hypoechoic mass suggest a solid nature.

Teaching Point:

Color doppler signals and CEUS Arterial phase, both show evidence of internal vascularity within this mass. Color doppler alone confirms the solid nature of the mass and CEUS shows both Arterial Phase hyperenhancement and Rapid washout. Suggesting a solid mass, of non- hepatocellular origin.

Teaching Point:

This Mass is shown after observation with CEUS for 3mins. The Mass shows Marked/Strong washout. APHE and Rapid washout – at 1minute, becoming Marked/Strong at 3mins, further confirms a mass that has a non-hepatocellular origin. These tumors always require biopsy to confirm pathology. This is a Biopsy confirmed Lymphoma. In routine practice this pattern would more often suggest another non-hepatocellular pathology, Cholangiocarcinoma. This patient’s final diagnosis is Lymphoma. (biopsy proven)
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