echoreiche Leberherde

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.

Benign

• 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
• lipoma

Malignant

• hepatic metastases
  • colorectal carcinoma (up to 50% of hyperechoic liver metastases)
  • treated breast cancer
  • endocrine tumors of the pancreas
  • renal cell carcinoma
  • thyroid carcinoma
  • melanoma
  • some sarcomas
  • choriocarcinoma
• hepatocellular carcinoma: particularly in a cirrhotic liver
• cholangiocarcinoma

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).

Radiographic features

Ultrasound

• 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 .

Practical points

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.

See also

• fat containing liver lesions

Siehe auch:

• Leberhämangiom
• fetthaltige Leberläsionen
• hepatozelluläres Karzinom
• Lebermetastasen
• Leberadenom
• cholangiozelluläres Karzinom
• Fokale noduläre Hyperplasie
• inflammatorischer Pseudotumor der Leber
• Lebermetastasen neuroendokriner Tumoren
• hypo-echoic halo sign
• focal fatty change - focal hepatic steatosis

und weiter:

• sonographic halo sign
• Leberläsionen Echogenität