Ultrasound Appearance of Common Focal Hepatic Lesions

Ultrasound appearance of common benign and malignant focal hepatic lesions

Ultrasound Appearance of Common Focal Hepatic Lesions

CystAnechoic, well-demarcated thin wall, well-defined back wall, posterior acoustic enhancementCysts complicated by hemorrhage or infection can develop a thick wall, internal echoes, and/or septations
HemangiomaWell-defined, homogeneously hyperechoic (most common), hypoechoic center with echogenic border (less common)More common in women, up to 10% are multiple
Focal nodular hyperplasia (FNH)Similar echogenicity to adjacent liver, central scar variably seen as hypoechoic centerMore common in women, subtle benign lesion
AdenomaVariable appearance from hypoechoic to hyperechoic (with hemorrhage)Associated with oral contraceptive agents, and with increased risk of hemorrhage and malignant degeneration
Focal hepatic steatosisRegion of increased echogenicity compared to normal liver backgroundCan change rapidly, no mass effect, most commonly anterior to portal vein at porta hepatis
Focal fatty sparingRegion of decreased echogenicity compared to abnormal echogenic liver backgroundMost commonly anterior to portal vein at porta hepatis, or adjacent to gallbladder fossa
Hepatocellular carcinoma (HCC)Variable appearance; when small (<5 cm) hypoechoic, with time and increasing size more complex and inhomogeneous due to necrosis, fibrosis, or fatty change, sometimes with peripheral hypoechoic haloMay be a solitary nodule, multiple nodules, or diffuse infiltration, sometimes with portal vein invasion
MetastasisVariable appearance from echogenic, hypoechoic, target, calcified, or cystic; hypoechoic haloMore commonly multiple, with variably sized liver masses
AbscessComplex cystic appearance with variable luminal echogenicity from anechoic to highly echogenic, fluid-fluid levels, septations, debris, variable wall thickness, or gasMost commonly secondary to seeding from intestinal sources

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