Presentation
RUQ pain.
Patient Data
The liver is mildly enlarged measuring 15.9 cm in the mid clavicular line and demonstrates diffusely increased echogenicity in keeping with fatty infiltration. There is a small area of focal fatty sparing seen adjacent to the gallbladder.
Within segment II of the liver, there is a heterogeneous lesion, which is predominantly hypoechoic, with ill-defined margins, measuring approximately 5.0 x 4.5 x 4.3 cm. No internal vascularity demonstrated within this.
The lesion within the left lobe of the liver is mildly hypodense on non-contrast imaging. This demonstrates peripheral nodular enhancement on the arterial phase imaging, with progressive and more central enhancement on portal venous and delayed phase imaging. The lesion has approximate dimensions of 50 x 55 x 43 mm (AP x ML x SI).
The liver appears diffusely mildly hypoattenuating in keeping with mild fatty infiltration. There is a tiny hypodense focus within segment VIII of the liver measuring 4 mm which is too small to further characterize.
The gallbladder, spleen, adrenal glands and kidneys are unremarkable in appearance. There is a small volume of stranding seen around the pancreas, particularly the pancreatic tail. The pancreas itself demonstrates homogeneous enhancement.
Ill-defined nodular ground-glass density within both lower lobes and the visualized posterior aspect of the right middle lobe. There is also mild bronchial wall thickening seen within both visualized lower lobes.
Comment:
Case Discussion
Incidental focal liver lesion in an adult patient with diffuse steatosis. As most solid liver lesions on ultrasound, appearances are non-specific and, at this age, primary or secondary liver malignancy needs consideration. Workup with 4phase liver CT was recommended and demonstrated typical features of liver hemangioma, including a few other smaller benign lesions not seen on ultrasound.
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