Targetlike Appearance of Pseudotumors in Segment IV of the Liver on  Sonography

Rubaltelli, Léopoldo; Savastano, Sergio; Khadivi, Yeganeh; Stramare, Roberto; Tregnaghi, Alberto; Pian, Pierpaolo Da

doi:10.2214/ajr.178.1.1780075

Cited by 24 publications

(15 citation statements)

References 11 publications

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“…For instance, hypoechoic pseudotumors found in the fatty liver are frequently located in the gall bladder fossa or anterior part to the portal vein. 1 On the other hand, hyperechoic pseudotumors due to focal fatty infi ltration are found mainly in the medial segment of the left lobe. 2 However, such pseudotumors usually do not spread over the liver.…”

Section: Multiple Hepatic Pseudotumors On Sonographymentioning

confidence: 99%

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Multiple hepatic pseudotumors on sonography

et al. 2007

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Hepatic pseudotumors mimicking metastatic disease detected on ultrasonography are usually located in a specifi c part of the liver. For instance, hypoechoic pseudotumors found in the fatty liver are frequently located in the gall bladder fossa or anterior part to the portal vein. 1 On the other hand, hyperechoic pseudotumors due to focal fatty infi ltration are found mainly in the medial segment of the left lobe. 2 However, such pseudotumors usually do not spread over the liver. 3 We have experienced a rare case of multiple hyperechoic pseudotumors spreading to the whole liver.A 58-year-old man, who drank approximately 550 ml of sake (50 g of ethanol) a day, visited us for a liver function test. Blood analyses showed an increase in α-glutamyl transpeptidase (163 IU/ l), but other liver function data as well as complete blood cell counts were within normal limits. Tumor markers including α-fetoprotein (5.9 ng/ml), carcinoembryonic antigen (4.2 ng/ml), and carbohydrate antigen 19-9 (6.2 U/ml) were also in the normal range. Ultrasonography showed a number of high-echogenic ovalshaped areas with diameters of around 1 cm throughout the liver (Fig. 1A). Computed tomography (CT) demonstrated the presence of multiple low-density areas (Fig. 1B) that were slightly enhanced in the arterial phase (Fig. 1C) and then enhanced equally in the surrounding tissues in the subsequent portal phase of the dynamic study (data not shown). Similar fi ndings were obtained when the patient was examined by CT hepatic arteriography and CT arterial portography. No remarkable fi nding was obtained when he was examined by magnetic resonance imaging (MRI) or positron emission tomography. Sonographically guided biopsy specimens showed slight fatty degeneration of hepatocytes (Fig. 1D). The follow-up sonographic examination after 12 months showed little change in the shape of pseudotumors.Nodular parenchymal fatty infi ltration has been reported as a cause of the hyperechogenicity of most pseudotumors. 1-3 Nonportal venous supply to the liver has been suggested to contribute to focal fat deposits. 4 However, in the present case, only a slight fatty change was observed in the biopsy specimens, and thus the histological background of the echogenicity remains to be further elucidated.Multifocal pseudotumors mimicking metastatic tumors are sometimes encountered on diagnostic modalities including ultrasonography, CT, and MRI. 5 Confi rmation of diagnosis often requires invasive procedures, and thus such lesions are still of clinical relevance. The present case may be informative for diagnosing multiple tumorous lesions of the liver.

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Section: Multiple Hepatic Pseudotumors On Sonographymentioning

confidence: 99%

“…1 Recently, nodular lesions associated with IPH have been reported, and most of these nodular lesions are hyperplastic. 2,3 However, hepatocellular carcinoma (HCC) arising in IPH is rare.…”

Section: Hepatocellular Carcinoma Developing Six and A Half Years Aftmentioning

confidence: 99%

Multiple hepatic pseudotumors on sonography

et al. 2007

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“…Focal spared areas in fatty liver have been described in several papers and their typical and most frequent features on helical CT are well known [6,15,16]. However, there have been some reports that have emphasised that pseudolesions in fatty liver may have an atypical and equivocal appearance [17][18][19]. Therefore, in some cases, focal spared areas may be misinterpreted as true lesions, thus leading to incorrect patient management or additional examinations, including liver biopsy, to ascertain the diagnosis [19,20].…”

Section: Introductionmentioning

confidence: 99%

“…However, there have been some reports that have emphasised that pseudolesions in fatty liver may have an atypical and equivocal appearance [17][18][19]. Therefore, in some cases, focal spared areas may be misinterpreted as true lesions, thus leading to incorrect patient management or additional examinations, including liver biopsy, to ascertain the diagnosis [19,20]. Conversely, when a true lesion is present, its definitive characterisation may be challenging on imaging examination when the liver is diffusely fatty [21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

Differentiation between true focal liver lesions and pseudolesions in patients with fatty liver: evaluation of helical CT criteria

et al. 2010

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“…T he sonographic ''bull's eye'' or target pattern of liver lesions is characterized by a peripheral hypoechoic halo encircling a central hyperechoic core [1,2]. Although these target-like lesions almost always are metastases or mycotic abscesses (usually caused by Candida albicans, being considered a classic finding for this diagnosis) [1,2,3], conditions such as localized lymphomatosis, hepatocellular carcinoma, and pseudotumors in segment IV also present with this finding [2].…”

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confidence: 99%