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Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Liver mass echocardiography and ultrasound

Introduction

Overview

Overview

Ultrasound is the initial method of choice for the evaluation of liver mass. On ultrasound, characteristic findings of liver mass, may include: fluid-filled spaces without clear walls, posterior acoustic enhancement, anechoic, hypoechoic, or hyperechoic lesions. The evaluation of liver mass will mainly depend on the echogenicity. Further evaluation with ultrasound should include Doppler examination to determine vascular pattern.

Ultrasound

Ultrasound

Ultrasound is the initial method of choice for the evaluation of liver mass. The evaluation of liver mass will mainly depend on echogenicity.[1][2]

  • On ultrasound, characteristic findings of liver mass may include:
    • Fluid-filled spaces without clear walls
    • Posterior acoustic enhancement
    • Anechoic, hypoechoic, or hyperechoic lesions

Methods

Evaluation with ultrasound should include the following techniques:[2]
  • Doppler examination
  • Contrast-enhanced ultrasound
Type Ultrasound Enhanced ultrasound
Benign liver mass
  • Homogeneous hyperechogenicity
  • Hypoechogenicity with hyperechoic ring
  • Posterior sonic enhancement
  • Wash out during portal venous phase regardless of arterial vascularity
Malignant liver mass
  • Hypoechoic halo
  • Target appearance
  • No wash-out during portal phase
  • Central scar: large central artery is usually present with spoke-wheel like centrifugal flow
  • Sonographic halo sign: hypoechoic halo sign in liver metastases: used in hepatobiliary imaging, is a concerning feature for malignant lesion if the lesion is a hyperechoic liver lesion

The table below summarizes the characteristic ultrasound findings of common benign and malignant liver masses.

Ultrasound findings of common liver masses
Common liver masses Ultrasound finding
Hepatic hemangioma
  • Well-demarcated
  • Homogeneous
  • Hyperechoic mass
  • May be hypoechoic in patients with fatty infiltration
Focal nodular hyperplasia
  • Detectable lesions
  • Central scar with displacement of peripheral vasculature (Doppler examination)
Hepatic adenoma
  • Large
  • Right lobe of the liver
  • Central hypoechoic region
Idiopathic noncirrhotic portal hypertension
  • Isoechoic lesions
Hepatocellular carcinoma
  • Poorly-defined margins
  • Coarse, irregular internal echoes
Cholangiocarcinoma
  • Hypo-, iso-, or hyperechoic
  • Homogenous or heterogenous
Metastases
  • Metastases from adenocarcinoma
  • Multiple and hypoechoic in comparison with the surrounding liver parenchyma
References

References

  1. ↑ Bonder A, Afdhal N (2012). “Evaluation of liver lesions”. Clin Liver Dis. 16 (2): 271–83. doi:10.1016/j.cld.2012.03.001. PMID 22541698.
  2. ↑ 2.0 2.1 Wilson SR, Jang HJ, Kim TK, Burns PN (2007). “Diagnosis of focal liver masses on ultrasonography: comparison of unenhanced and contrast-enhanced scans”. J Ultrasound Med. 26 (6): 775–87, quiz 788–90. PMID 17526609.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]