This document discusses the ultrasound imaging appearance of various complex or solid liver masses. It includes 19 figures showing ultrasound images of different pathologies that can present as liver masses such as hepatocellular carcinoma, metastases, abscesses, hemangioma, echinococcal cysts, focal nodular hyperplasia, and cholangiocarcinoma among others. Each figure is accompanied by a brief description of the imaging finding depicted.

1. 69Complex or Solid Liver Masses

2. CLINICAL IMAGAGING
AN ATLAS OF DIFFERENTIAL DAIGNOSIS
EISENBERG
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig GI 69-1 Hepatoma. Complex mass (arrows)
with a large echogenic component.

4. • Fig GI 69-2 Multinodular hepatocellular
carcinoma mimicking metastatic disease.
Sagittal scan demonstrates multiple
hyperechoic masses.95

5. • Fig GI 69-3 Metastasis. Sagittal scan shows a large
echogenic mass (arrows) with central necrosis. (C,
inferior vena cava.)96

6. • Fig GI 69-4 Multiple metastases. Sagittal scan
demonstrates multiple hypoechoic masses (m)
in the liver (L). Note the prominent ascitic fluid
(A). (K, kidney.)95

7. • Fig GI 69-5 Diffuse metastases. Transverse
scan shows a heterogeneous echo pattern in
which areas of hypoechogenicity are mixed
with hyperechogenic regions. (L, liver.)95

8. • Fig GI 69-6 Pyogenic hepatic abscess. Ill-
defined complex mass with irregular margins.

9. • Fig GI 69-7 Hepatic abscess. Large, solid-
appearing mass (A) in the right lobe of the
liver in a young man with fever and pain in the
right upper quadrant.97

10. • Fig GI 69-8 Candida albicans abscesses.
Numerous, rounded, fluid-filled lesions
(arrows) with a target appearance.98

11. Fig GI 69-9 Hemangioma. Transverse sonogram shows a
characteristic hyperechoic mass containing homogeneous
echoes. (L, liver.)95

12. • Fig GI 69-10 Echinococcal cyst. (A) Three
distinct daughter cysts (arrows) with the
typical peripheral location within the mother
cyst.99 Hydatid matrix with a solid appearance
is seen filling the rest of the cavity. (B) A
hydatid cyst in the right lobe of the liver
contains wavy bands of delaminated endocyst
(water lily sign) (arrows).100

13. • Fig GI 69-11 Echinococcal multilocularis cyst.
Transverse sonogram of the liver shows a
typical hailstorm pattern, characterized by
multiple echogenic nodules with irregular and
indistinct margins.100

14. • Fig GI 69-12 Schistosomiasis. Longitudinal sonogram
through the liver shows the characteristic network pattern,
with echogenic septa (arrows) outlining polygonal areas of
relatively normal liver parenchyma.100

15. • Fig GI 69-13 Ascariasis. (A) Sagittal sonogram of
the porta hepatic shows a tubular echogenic
region (arrow) within the slightly dilated common
bile duct (arrowheads). (B) Oblique sonogram in a
slightly different plane shows the echogenic
region in lengthwise section (open arrow) in the
common hepatic and common bile ducts and in
cross section (solid arrow) more distally in the
common bile duct. The intraluminal abnormality
measured approximately 5 mm. The arrowhead
denotes the common bile duct.101

16. • Fig GI 69-14 Focal nodular hyperplasia. The
hyperechoic mass (between cursor marks) has
a central scar (arrows) and was found in an
otherwise normal liver. The middle hepatic
vein (v) is displaced.102

17. • Fig GI 69-15 Hepatic adenoma. Well-defined
exophytic right lobe mass (M) containing
heterogeneous internal echoes in a young
woman taking oral contraceptive pills.102

18. Fig GI 69-16 Hemangioendothelioma. Sagittal sonogram shows
multiple, discrete, hypoechoic solid masses.103

19. • Fig GI 69-17 Hepatoblastoma. Transverse scan
demonstrates the echogenic mass.32

20. Fig GI 69-18 Fibrolamellar carcinoma. Sonogram shows mixed
echogenicity and calcification (curved arrow) within a mass
(straight arrow).104

21. • Fig GI 69-19 Intrahepatic cholangiocarcinoma.
Sagittal scan shows a large hyperechoic mass
in the right lobe of the liver.105

22. Fig GI 69-20 Biliary cystadenoma. Multiloculated liver mass. Note
that the internal septa show nodular thickening and papillary
excrescences.106

23. • Fig GI 69-21 Focal fatty infiltration. Axial sonogram of
the liver shows an ovoid, uniformly hyperechoic focus
(arrow) consistent with a localized collection of fat.107

24. • Fig GI 69-22 Multifocal nodular fatty infiltration. Axial sonogram
shows a diffuse pattern of patchy hyperechoic foci (arrow)
simulating an infiltrative tumor. The combination of in-phase and
opposed-phased MR imaging allows this appearance to be reliably
differentiated from metastatic disease.107

25. • Fig GI 69-23 Lipoma. Axial sonogram shows
uniformly hyperechoic lesions (arrow).107