Breast carcinoma.

HISTORY: 61-year-old female with breast carcinoma.

FINDINGS: Images 1 and 2 are transverse scans of the liver and pancreas

demonstrating enlarged periportal lymph nodes (arrows).  On Image 3

there is diffuse heterogeneity of the hepatic echogenicity with poor

definition of intrahepatic vasculature.  On Image 4 there are discrete

hepatic lesions with peripheral halos suggesting space occupying lesions

(arrow).

DIAGNOSIS: Metastatic breast carcinoma to the liver and periportal lymph

nodes.

DISCUSSION: Carcinoma of the breast when metastatic to the liver often

produces very subtle sonographic findings.  Not infrequently, there is a

pattern of diffuse heterogeneity without discrete focal lesions.  As in

this case, individual metastases are difficult to identify and there is

a generalized appearance of altered echogenicity of the parenchymal

echotexture.  Metastatic nodes are evident in the porta hepatis.

Sonographic features of liver lesions suggesting malignancy include

peripheral halos and refractive shadows.  These findings are unusual for

benign lesions.  In addition to metastatic carcinoma, the differential

diagnosis of the periportal adenopathy includes lymphoma.  Periportal

adenopathy may also be due to infectious etiologies such as tuberculosis

and MAI and viral hepatitis particularly when chronic.