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Hemangioma of the liver CEUS
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Presentation Patient with a known hyperechoic focal liver lesion, for CEUS study to characterize lesion.
Caption: Sagittal liver
Description: A large predominantly hyperechoic lesion is seen in the liver.
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.
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.
Differential Diagnosis Metastasis, hemangioma, HCC, cholangiocarcinoma, adenoma
Final Diagnosis Hemangioma
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)
Case 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
Technical Details Contrast Agent: SonoVue (Bracco)
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