Ultrasound appearance of common benign and malignant focal hepatic lesions
Ultrasound Appearance of Common Focal Hepatic Lesions
| LESION | Ultrasound APPEARANCE | ADDITIONAL FEATURES |
|---|---|---|
| Cyst | Anechoic, well-demarcated thin wall, well-defined back wall, posterior acoustic enhancement | Cysts complicated by hemorrhage or infection can develop a thick wall, internal echoes, and/or septations |
| Hemangioma | Well-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 center | More common in women, subtle benign lesion |
| Adenoma | Variable appearance from hypoechoic to hyperechoic (with hemorrhage) | Associated with oral contraceptive agents, and with increased risk of hemorrhage and malignant degeneration |
| Focal hepatic steatosis | Region of increased echogenicity compared to normal liver background | Can change rapidly, no mass effect, most commonly anterior to portal vein at porta hepatis |
| Focal fatty sparing | Region of decreased echogenicity compared to abnormal echogenic liver background | Most 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 halo | May be a solitary nodule, multiple nodules, or diffuse infiltration, sometimes with portal vein invasion |
| Metastasis | Variable appearance from echogenic, hypoechoic, target, calcified, or cystic; hypoechoic halo | More commonly multiple, with variably sized liver masses |
| Abscess | Complex cystic appearance with variable luminal echogenicity from anechoic to highly echogenic, fluid-fluid levels, septations, debris, variable wall thickness, or gas | Most commonly secondary to seeding from intestinal sources |
