Teaching Case

Fortuitous discovery of multiple hyperechoic liver nodules.

Chronic abdominal pain. Ultrasound examination showed multiple hyperechoic liver nodules. Hepatic biology parameters were normal.

Liver hemangiomas are very common. Usually they are frankly hyperechoic, well limited, except in case of underliyng liver steatosis. Diagnostic certitude, if there is some doubt after ultrasound, is better obtained by MRI giving structural information (hypersignal on T2-weighted sequences) together with dynamic enhancement. CT-scan is less efficient but can also show the centripetal progressive enhancement. The timing of enhancement is depending of the level of lesion vacularity, leading to different aspects from hypervascular lesions to hypodense lesions with a very slow enhancement. The presence of small periphal nodules at arterial phase.