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Hemangioma of the liver CEUS

Technical: Contrast Agent: SonoVue (Bracco)

Presentation: Patient with a known hyperechoic focal liver lesion, for CEUS study to characterize lesion.

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Caption: Sagittal liver    
Description: A large predominantly hyperechoic lesion is seen in the liver.

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Caption: Post contrast injection: Arterial phase
Description: In the arterial phase a globular enhancement is visible at the margin of the lesion, slowly  progressing centripetally towards the center  of the lesion.

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Caption: Portal-venous Phase
Description: In the portal-venous phase the lesion shows progressing contrast fill-in, becoming completely enhanced in the late phase.

Caption: Contrast-enhanced ultrasound video clip.

Discussion: This lesion exhibits a typical enhancement pattern of hemangioma. Arterial phase: peripheral-nodular enhancement, no central enhancement. In PV phase: partial/complete centripetal filling. In Late phase: complete enhancement of lesion.   Variations include rim enhancement in the arterial phase, and for small lesions, complete rapid centripetal enhancement. Hemangiomas may have non-enhancing areas in late phase. (1)

Differential: Metastasis, hemangioma, HCC, cholangiocarcinoma, adenoma

Final: Hemangioma


References: 1. EFSUMB study group et al.: Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) - Update 2008 http://www.efsumb.org/mediafiles01/ceus-guidelines2008.pdf