Patient History: A 61 year old male presented with complaints of abdominal discomfort and digestion irregularity. A complete abdomen was performed to rule out gallstones.
Images:
Image1: Sag lt liver
Image 2: Sag lt liver
Image 2: sag Rt liver
Discussion. The above images show a hyperechoic solid mass seen near the the Left Portal vein measuring 1.0x1.2x1.5cm . Color Doppler was used to show the mass increased vascularity. Also seen are multiple echogenic vessel walls scattered throughout the liver.
16 comments:
As given some clues, like well-defined solid lesion, hyperechoic liver mass with vascularity. Some pathologies are the top of my head. The tumors might be associated with focal nodular hyperplasia. however, I am not quite sure yet.
I think it might be a hemangioma. They usually present as a well curcumscribed hyperechoic mass
Hello Irene
I thing it is an hemangioma even if most of the time there are asymptomatic.
Jessica and Zouliath are right but you guys are missing something in my discussion. If you read closely, you'll see that there isn't only hemangioma present. Let's see who will guess right.
A typical hyperechoic hemangioma is seen. There appears to be a shadow in Pic #1, but it's small for me to be able to tell if it's an artifact, or if it's being caused by a stone. The vessels showing color look awkward too for some reason...
More clues, Irene??
Hi Irene,
Very interesting case! It does appear that there is an incidental hemangioma in the left liver. The liver parenchyma seems very hypoechoic with hyperechoic portal vein walls. Considering this ultrasound finding and the patient's GI symptoms, I think he may be suffering from acute hepatitis....
Since Irene has already confirmed the presence of the Hemangioma. I'll comment that I'll concur that the "starry-sky" effect present in the liver (brightness of the periportal cuffing) strongly suggests Hepatitis.
I guess it is chronic hepatitis, but I can't gurantee whether it is acute or chronic hepatitis. There are two distinct ultrasound patterns were detected. In acute hepatitis, the predominant findings were accentuated brightness and more extensive demonstration of the portal vein radicle walls and overall decreased echogenicity of the liver. Chronic hepatitis primarily revealed decreased brightness and number of portal vein radicle walls and overall increased liver echogenicity.
I think this is a cavernous hemangioma. Most cavernous hemangioma do not produce symptons, however, in rare cases, a carvernous hemangioma may rupture.
Hye said.
My first impression of the hypoechoic liver with bright portal walls was also acute hepatitis. A classic "starry night" appearance as Alexia mentioned. In chronic hepatitis the liver echotexture becomes brighter. I wasn't sure what the lesion was, I originally thought it was talking about a clot but then I saw that the lesion was intrahepatic..
do you know that Hemangiomas, although referred to as tumors, are not malignant and do not become cancerous!
Tia, and Alexia got it right. Its a hemangioma and acute hepatitis.
Thanks for the comments.
Some signs and symptoms of acute hepatitis are profound loss of appetite, dark urine, abdominal discomfort, hepatomegaly, spleenomegaly and gallbladder wall thickening.
Hepatic hemangiomas can occur at any time, but are most common in people in their 30s - 50s. Women are affected more often than men, and usually have bigger tumors than men.
We scanned a patient today and my CI thought that we saw a hemangioma, it was a hyperechoic mass. We turned on it sag. It was a round ligament, with some fat.
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