Ultrasound findings in peliosis hepatis

Abstract

Purpose: The aim of this study was to retrospectively evaluate contrast-enhanced ultrasound (CEUS) findings in patients with peliosis hepatis (PH).Methods: A retrospective analysis was conducted of CEUS features in 24 patients with histopathologically confirmed PH (11 men and 13 women; mean age, 32.4±7.1 years; range, 28 to 41 years). All lesions were histologically proven, either by core needle biopsy (n=10) or by hepatic surgery (n=14).Results: The mean size was 36.8±12.4 mm (range, 10 to 80 mm). On B-mode ultrasonography (BMUS), all PH lesions were heterogeneously hypoechoic, with well-defined margins but irregular shapes. No mass effect was observed. During the arterial phase of CEUS, all lesions displayed mild heterogeneous hyperenhancement (83.3%, 20/24) or isoenhancement (16.7%, 4/24). Furthermore, 87.5% of the PH lesions showed mild washout after 1 minute in the portal venous phase (30-120 seconds) and mild washout in the late phase (>120 seconds).Conclusion: The lack of a mass effect on BMUS, mild heterogeneous arterial hyperenhancement, and washout in the very late portal venous phase (after 1 minute) on CEUS are characteristic of PH. Although it is a histological diagnosis, PH should be considered in the differential diagnosis when the clinical context does not favor a malignancy or infection.

Solitary peliosis hepatis mimics a liver metastasis on contrast-enhanced ultrasound

“…In comparison to the results of the study by Dong et al., the lesion we present is in congruence with the described arterial hyperenhancement—but our case showed early progressive washout, whereas the authors concluded washout in the very late portal venous phase (after 1 minute) to be characteristic in peliosis hepatis [3] . Furthermore, 83.3% of the included lesions were described to be heterogeneously hypoechoic, whereas the case we present had hyperechoic appearance in B-mode US [3] .…”

“…Perfusion pattern of peliosis hepatis in CEUS are quite variable including a variety of B-mode findings with hyper-, iso- and hypoechogenicity [3 , 4] . While the solitary FLL showed no PET avidity, CEUS clearly identified suspicious contrast enhancement pattern in form of early, irregular arterial inflow without following a typical enhancement pattern known for haemangioma or focal nodular hyperplasia.…”

“…Although the pathogenesis remains unclear, histopathological postsinusoidal obstruction were hypothesized to be a potential mechanism [1] . According to current literature, only a small number of case reports and a study including 24 patients [3] demonstrated perfusion pattern on contrast-enhanced ultrasound (CEUS). Thus, we are demonstrating a case with peliosis hepatis mimicking a liver metastasis in a patient during late follow-up of a malignant melanoma.…”

Imaging Features of Hepatocellular Carcinoma in the Non-Cirrhotic Liver with Sonazoid-Enhanced Contrast-Enhanced Ultrasound

“…According to current guidelines, the washout feature of CEUS is an important clue for distinguishing malignant from benign FLLs [ 11 , 25 ]. However, previous studies also showed that not all HCCs show washout during the late phase.…”

Comments and illustrations of the WFUMB CEUS liver guidelines: Rare focal liver lesion – infectious parasitic, fungus

“…In recent years, conventional ultrasound (US) and CEUS features of less common FLL and vascular have been described in detail [6][7][8][9][10]. In this current paper series, we aim to summarize the US and CEUS features of very rare FLL where there are limited reports and figures published in order to create a library of these rare lesions [10][11][12][13][14][15][16][17][18][19]. Parasites and fungal diseases have manifestations in the liver that pose a diagnostic challenge.…”