HISTORY: Right upper quadrant pain, rule out gallstones.
FINDINGS: Images 1-5 are transverse scans of the liver. In Image 1
there is a well-defined echogenic mass seen in the posterior segment of
the right lobe of the liver. Images 2 and 3 demonstrate a mass in the
anterior segment of the right lobe that has slightly increased
echogenicity compared to normal liver (arrows, Image 2). Images 4 and 5
are color Doppler sonograms of the mass in the anterior segment of theright lobe demonstrating intrinsic flow.
DIAGNOSIS: Focal nodular hyperplasia associated with cavernous
hemangioma of the liver.
DISCUSSION: There is an increased incidence of focal nodular hyperplasia
(FNH) in patients with hemangioma of the liver. Sonographically,
hemangiomas demonstrate a variable appearance, but when small, they are
typically hyperechoic in appearance with slight distal enhanced throughsound transmission. An important negative finding is lack of a
peripheral hypoechoic halo and a lack of refractive shadowing. FNH may
be quite subtle to detect with grayscale imaging as the echogenicity is
very similar to the normal liver. The color Doppler sonograms are
useful to demonstrate increased intrinsic flow within the lesion quite
typical of FNH. Intrinsic flow can also be seen with malignant lesions
such as hepatocellular carcinoma and some metastatic lesions.
Therefore, this finding is nonspecific and requires other confirmatory
studies such as nuclear medicine examination or MRI.
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