Case of the Day: What is that Mass?

Teaching Point:

The brighter or hyperechoic components within this mass could represent solid components. However, when there is a complex cystic mass on ultrasound it is challenging to differentiate a cyst complicated by hemorrhage from a malignant tumor.

Teaching Point:

A small speck of flow is demonstrated in the Anterior portion of the mass. Color doppler adds more information. However, color doppler can be insensitive to blood flow at this depth within a mass. CEUS was added to confirm the findings.

Teaching Point:

CEUS gives an accurate look at blood flow at the perfusion level. CEUS definitively shows that the mass in question and all of the cysts are completely avascular. Therefore, this complicated looking mass represents a cyst with hemorrhage and clot. The Addition of CEUS, is valuable as it can redirect this patient to more conservative management.