A hyperechoic liver lesion on ultrasound can arise from a number of entities, both benign and malignant. A benign hepatic hemangioma is the most common entity encountered, but in patients with atypical findings or risk for malignancy, other entities must be considered.
- hepatic hemangioma: commonest hyperechoic liver lesion by far (present in 4% of the population)
- focal nodular hyperplasia
- hepatic adenoma with high fat content
- focal fatty change: focal hepatic steatosis
- hepatic angiomyolipoma
- inflammatory pseudotumor of the liver
- hepatic metastases
- hepatocellular carcinoma: particularly in a cirrhotic liver
The presence of hyperechogenicity can be a result of fat within a liver lesion , although some non-fat-containing lesions may also be echogenic (e.g. hepatic hemangioma).
- hypoechoic halo sign: considered a feature suggestive of malignancy
Some suggest pulse inversion harmonic imaging with quantitative evaluation as being useful in facilitating the differential diagnosis of hyperechoic focal liver lesions, where a lesion-liver ratio of ≥1 being predictive of a benign nature, assuming that malignant lesions show a ratio of <1 .
If a single, well-defined, homogeneous, echogenic mass <3 cm is found in an asymptomatic patient, without a history of malignancy and without risk factors for liver tumors, then a diagnosis of hemangioma can be made on ultrasound without the need for another test . If an appropriate clinical history is not available, then a wider differential is appropriate.
- fetthaltige Leberläsionen
- hepatozelluläres Karzinom
- cholangiozelluläres Karzinom
- Fokale noduläre Hyperplasie
- inflammatorischer Pseudotumor der Leber
- neuroendocrine liver metastases
- hypo-echoic halo sign
- focal fatty change - focal hepatic steatosis