Diagnostic ultrasound ( PDFDrive )

108 PART II Abdominal and Pelvic Sonography
TABLE 4.3 Schematic of Algorithm for Liver Mass Diagnosis on
Contrast-Enhanced Ultrasound
Hemangioma
or
AP
Peripheral nodular enhancement
Centripetal progression of enhancement
PVP
Complete or partial fill-in
FNH
Adenoma
or
AP
Centrifugal hypervascular enhancement
Stellate arteries
PVP
Sustained enhancement
Hypoechoic central scar
AP
Diffuse or centripetal hypervascular enhancement
Dysmorphic arteries
PVP
Sustained enhancement
Soft wash out
Metastases
or
or
AP
Rim enhancement
Diffuse hypervascular
Hypovascular
PVP
Fast washout
Arterial phase (AP)
Portal venous phase (PVP)
(+) Enhancement Soft wash out
(–) enhancement
(wash out)
AP, Arterial phase; FNH, focal nodular hyperplasia; PVP, portal venous phase.
With permission from Wilson SR, Burns PN. Microbubble-enhanced US in body imaging: what role? Radiology. 2010;257(1):24-39. 148
• Multiple solid liver masses may be signiicant and suggest
possible metastatic or multifocal malignant liver disease.
However, hemangiomas are also frequently multiple.
• Clinical history of malignancy, chronic liver disease or
hepatitis, and symptoms referable to the liver are requisite
information for interpretation of a focal liver lesion.
Benign Hepatic Neoplasms
Cavernous Hemangioma
Cavernous hemangiomas are the most common benign tumors
of the liver, occurring in approximately 4% of the population.
hey occur in all age groups but are more common in adults,
particularly women, with a female-to-male ratio of approximately
5:1. Histologically, hemangiomas consist of multiple vascular
channels that are lined by a single layer of endothelium and
separated and supported by ibrous septa. he vascular spaces
may contain thrombi.
he vast majority of hemangiomas are small, asymptomatic,
and discovered incidentally. Large lesions may, in rare cases,
produce symptoms of acute abdominal pain, caused by hemorrhage
or thrombosis within the tumor. hrombocytopenia, caused
by sequestration and destruction of platelets within a large
cavernous hemangioma (Kasabach-Merritt syndrome), occasionally
occurs in infants and is rare in adults.
Traditional teaching suggests that once identiied in the adult,
hemangiomas usually have reached a stable size, rarely changing
in appearance or size. 137,138 In our practice, however, we have
documented substantial growth of some lesions over many years
of follow-up. Hemangiomas may enlarge during pregnancy or
with the administration of estrogens, suggesting the tumor is
hormone dependent.