Lung cancer

HISTORY: Vague right upper quadrant pain with a prior history of lung cancer.

FINDINGS: Images 1 through 3 demonstrate multiple hypoechoic masses

within the right lobe of the liver (arrows).  Note on Images 3 and 4

there is slight enhanced through sound transmission.

DIAGNOSIS: Metastatic lung carcinoma to the liver.

DISCUSSION: There is a broad spectrum of the sonographic appearance of

hepatic metastasis.  The lesions run the entire gamut from predominantly

cystic metastasis (ovarian carcinoma) to typical solid hypoechoic

metastasis (as in this case) or echogenic lesions (as seen in both

metastatic colon and breast carcinoma).  Not infrequently there is a

peripheral hypoechoic halo around the lesion due to rapid enlargement of

the lesion or surrounding compressed hepatic parenchyma.  A biopsy was

performed under ultrasound guidance (Image 4).  Note the needle

placement within the lesion.  These findings are compatible with

squamous cell carcinoma from the patient's known lung cancer.

Biopsy is often essential to accurately diagnose the precise cause of a

liver mass.  In addition to metastatic disease, abscesses and other

complex fluid collections must be included in the differential

diagnosis.