Diagnostic ultrasound ( PDFDrive )

112 PART II Abdominal and Pelvic Sonography
A
B
C
D E F
G
H
I
FIG. 4.46 Hemangiomas: Spectrum of Appearances. Top row, Classic morphology. (A) Multiple small echogenic masses. (B) Single large,
lobulated echogenic mass. (C) Echogenic lobulated mass with a hypoechoic area centrally, probably related to central thrombosis or scarring. Middle
row, Atypical morphology. (D) Atypical hemangioma. It is hypoechoic and has a thin echogenic border. (E) Classic and atypical morphologies.
The atypical hemangioma has a thick, uniform echogenic border. (F) Atypical hemangioma is partially hypoechoic centrally with an irregular echogenic
rim. Bottom row, Infrequent observations. (G) Exophytic hemangioma bulging from the left lateral lobe of the liver. (H) Hypoechoic mass with
increased through transmission, a suggestive but infrequently encountered sign of hemangioma. (I) Central calciication in a hemangioma with
distal acoustic shadowing. This is a rare ending in hemangiomas.
Sclerosis of hemangioma creates diagnostic diiculty. In our
experience, these sclerotic hemangiomas mimic a malignant mass
on all modalities showing frequent portal venous phase washout
and lacking the classic peripheral discontinuous peripheral
globules or puddles that are virtually diagnostic of hemangioma
on contrast-enhanced studies. Biopsy is, therefore, frequently
necessary to conirm sclerotic hemangioma.
Focal Nodular Hyperplasia
FNH is the second most common benign liver mass ater
hemangioma. hese masses are believed to be developmental
hyperplastic lesions related to an area of congenital vascular
malformation, probably a preexisting arterial spider-like malformation.
151 Hormonal inluences may be a factor because FNH
is much more common in women than men, particularly in the