HISTORY: Rising liver function test protein in a patient with known
cirrhosis.
FINDINGS: Images 1-3 are high-resolution linear scans of the left lobe
of the liver demonstrating a well-defined echogenic mass. In Image 2,
there is clear-cut evidence of distal acoustic shadowing from the mass.
The liver capsule is bowed by the lesion. Image 3 is a pulse Dopplersonogram demonstrating high velocity vessels within the lesion.
Contrast-enhanced CT images demonstrate a recanalized umbilical vein
(best seen on Images 4 and 5) as well as a small focal lesion seen on
the lateral segment of the left lobe corresponding to the ultrasound
abnormalities. Note also the perisplenic varices on Image 7.
Percutaneous FNA biopsy revealed hepatocellular carcinoma.
DIAGNOSIS: Cirrhosis, portal hypertension, and hepatocellular carcinoma.
DISCUSSION: Small hepatocellular carcinomas may be quite echogenic andmay mimic hemangiomas in a patient with know cirrhosis. Unlike
hemangiomas, they may cause distal acoustic shadowing as well as have
intrinsic high velocity arterial flow. Most hemangiomas are avascular
with color Doppler sonography and if anything cause slight distalenhanced through sound transmission due to the fluid nature of the mass
(just tangled collections of hepatic sinusoids).
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