HISTORY: A 49-year-old female with known colon cancer, status post-

sigmoid resection 2 years ago.  Now with elevated liver function tests.

FINDINGS: Images 1 and 2 are transverse sonograms of the liver at the level of the junction of the right hepatic vein and intrahepatic IVC.

Note that there is a vague hypoechoic peripheral rim (arrows) around a

nearly isoechoic lesion.  There is increased echogenicity and acoustic shadowing indicative of calcification.  Notice that there is no visualization of the right hepatic vein as it is occluded by this mass.

Images 3 and 4 are contrast-enhanced CT scans demonstrating a calcified

low-density mass near the junction of the occluded right hepatic vein and the inferior vena cava.

DIAGNOSIS: Mucinous adenocarcinoma of the colon with calcified liver

metastasis.

DISCUSSION: This case demonstrates several features of hepatic metastasis on CT and sonography.  Unfortunately, many liver metastasis are nearly isoechoic and can only be recognized by the peripheral halo sign.  Histologically, this often relates to compressed hepatic

parenchyma from the growing tumor.  Calcification within a hepatic mass is non-specific; however, in the setting of prior colon carcinoma, it is strongly suggestive of metastatic disease to the liver. Other common hepatic lesions that calcify include granulomas, hepatocellular carcinoma, and occasionally widespread pneumocystis infection in patients with AIDS.  The CT confirmed calcification within the lesion and documents the occlusion of the right hepatic vein.