Case of the Day: What are the differential diagnoses for this worrisome new liver mass?

Teaching Point: Surveillance ultrasound is performed for at risk patients (cirrhosis, HBV, HCV, NAFLD etc.) to increase early detection of HCC which allows for earlier treatment and decreased mortality.

Teaching Point: Arterial phase hyperenhancement (APHE) on CEUS is a key feature for the diagnosis of HCC in at risk patients. Howver, APHE is also shown in many other benign and malignant tumors. Therefore, APHE contributes to many diagnoses but does not provide the whole answer.

Teaching Point:

Early washout, occurs at less than 60 seconds,

Late washout, occurs at greater than or equal to 60 seconds,

HCC within the LI-RADS 5 category, requires APHE and Late weak washout.

Here, we have early weak washout.

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Teaching Point:

Washout that is either rapid and/or marked in the portal venous phase in high risk livers is classified as LR-M.

Rapid weak washout with sustained weak washout led to our suspicion of HCC within the LR-M category.

LR-M includes metastases, ICC and also many HCC (30%). Because there are multiple generally malignant options within LR-M, biopsy is always recommended for this category.

This lesion was a biopsy confirmed HCC (hepatocellular carcinoma) and was classified as LR-M according to CEUS LI-RADS

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