Male with hepatitis-B

HISTORY: 59-year-old male with hepatitis-B; rule out hepatoma.

FINDINGS: Images 1 and 2 are sagittal and transverse scans of the left

lobe of the liver demonstrating a focal hepatic mass that is

characterized by peripheral hypoechogenicity and central areas of

increased echogenicity.  In addition, Image 3 demonstrates a small

echogenic focus in the right lobe.

Image 4 is a B-color image demonstrating a "mosaic" pattern of the left

lobe mass.  Color Doppler Images 5-7 demonstrate increased flow within

the left lobe mass.

DIAGNOSIS: Left lobe hepatoma in a patient with known hepatitis-B.

DISCUSSION: The sonographic features of hepatocellular carcinoma are

variable depending upon parenchymal and/or vascular invasion.  Lesions

may be hypoechoic, echogenic, or of mixed echogenicity.  Several

different morphologic features have been described including nodular or

conglomerate patterns and/or infiltrative patterns.  Not infrequently

hepatocellular carcinoma is multicentric, as in this case where there is

a small echogenic nidus of tumor noted in the right lobe.  The

sonographic pattern in this case may be described as a "mosaic pattern"

due to the alternating pattern of echogenic rounded foci and sonolucent

peripheral halos.  It is important to interrogate the portovenous system

with color Doppler to detect venous invasion in any patient with a focal

parenchymal mass.  Venous invasion strongly suggests primary

hepatocellular carcinoma.  With color Doppler, hepatocellular carcinoma

has intrinsic vasculature approximately 75% of the time.  Alternatively

patients with metastasis to the liver have extrinsic vascularity along

their contour 75% of the time and lack internal intrinsic vascularity.