CONTRAST ENHANCED ULTRASOUND IN THE DIAGNOSIS OF HEPATIC VASCULAR PSEUDOLESIONS – A CASE SERIES

• Published in: Ultrasound in medicine & biology Vol. 48; p. S66
• Main Authors: Sandulescu, Larisa, Ciocalteu, Adriana Ionescu, Sandulescu, Sarmis Marian, Urhut, Cristiana Marinela, Rosu, Andreea Alexandra, Rogoveanu, Ion
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 2022
• Subjects: contrast enhanced ultrasound; liver; pseudolesions; contrast enhanced ultrasound; liver; pseudolesions
• ISSN: 0301-5629; 1879-291X
• DOI: 10.1016/j.ultrasmedbio.2022.04.185

Hepatic pseudolesions are non- neoplastic abnormalities of the liver which may be sub- divided into parenchymal pseudolesions and vascular pseudolesions. Vascular pseudolesions include non- neoplastic hepatic pseudolesions such as intrahepatic shunts and vascular abnormalities associated with Budd- Chiari syndrome or portal vein thrombosis.
We present several cases of hepatic vascular pseudolesions, exemplified by 2D and contrast- enhanced ultrasound imaging (CEUS), to be considered in the differential diagnosis of real liver tumors.
First case belongs to a 63-year-old patient who was diagnosed with a liver abscess (LA) two years ago. Significant resolution of the LA was observed in the follow- up evaluation. In the vicinity of the residual abscess, Doppler US examination revealed a blood flow pattern with arterial and venous communication suggestive of arterio- portal shunt (APS). CEUS showed a homogeneous enhancement of this area and it also indicated the presence of the APS. Furthermore, an imprecisely delimited area with late and incomplete wash out was depicted in the late phase which led to differential diagnostic challenges with malignant tumors.
Another case of a 74- years- old man with vascular abnormalities associated with Budd- Chiari syndrome secondary to multicentric hepatocellular carcinoma is illustrated in this topic.
three cases with enhancement anomalies caused by portal vein thrombosis are also detailed in this paper.
The main clinical difficulty is to detect the non- neoplastic lesions and to discriminate between them and benign and malignant hepatic neoplasms. CEUS may be an useful tool for the characterization of hepatic vascular pseudolesions.