Diagnostic ultrasound ( PDFDrive )

128 PART II Abdominal and Pelvic Sonography
A
B
C
D E F
G
H
I
FIG. 4.61 Patterns of Metastatic Liver Disease. Top row, Echogenic lesions. (A) Multiple tiny echogenic metastases from choriocarcinoma.
(B) Colon metastasis with clump of calcium and distal acoustic shadowing. (C) Large, poorly differentiated metastatic adenocarcinoma, with tiny
punctate echogenicities suggesting microcalciication. Middle row, Hypoechoic lesions of increasing size from (D) pancreas; (E) lung; and (F)
adenocarcinoma, from unknown primaries. Bottom row, Cystic metastases. (G) Rare metastatic liposarcoma from the thigh. Metastasis has a
cystic growth pattern. (H) Metastatic sarcoma from the small bowel with necrosis, and (I) highly echogenic metastasis with a well-deined cystic
component, highly suggestive of metastatic carcinoid or neuroendocrine tumor.
appreciate on sonography, probably because of the loss of the
reference normal liver for comparison (Fig. 4.59G-I). In our
experience, breast and lung carcinomas, as well as malignant
melanomas, are the most common primary tumors to present
this pattern. he diagnosis can be even more diicult if the patient
has a fatty liver from chemotherapy. In these patients, CEUS,
CT, or MRI may be helpful. Segmental and lobar tumor iniltration
by secondary tumor may also be diicult to detect because it
may mimic other benign conditions, such as fatty iniltration
(Fig. 4.59D-F) or cirrhosis (Fig. 4.63).
CEUS plays a major role in the diagnosis and detection of
metastases. 136,206 Arterial phase enhancement is variable, although
most metastases, regardless of their expected enhancement, show
transient hypervascularity in the arterial phase, followed by rapid
washout. In the portal venous phase, metastases show washout,
which tends to be complete and also rapid, beginning within