Assessment of a biliary hamartoma with contrast-enhanced sonography using two different contrast agents.
A 49 year old male with carcinoma of the esophagus was staged using conventional US of the abdomen. US revealed signs of cirrhosis and a hyporeflexive focal liver lesion of about 5 mm in diameter was found. Low-MI contrast-enhanced ultrasound (CEUS) with SonoVue (Bracco, Milano, Italy) showed an enhancement pattern which was typical for benign liver lesions while high-MI CEUS with Levovist (Schering, Berlin, Germany) revealed a contrast defect in the liver late phase (4:30 min p. i.) which is typical for a malignant lesion. Due to these findings the lesion was evaluated as a potentially malignant lesion and a biopsy was performed. Histology showed a benign biliary hamartoma and incomplete cirrhosis. The findings confirmed that liver-specific contrast agents have the ability to detect very small focal liver lesions not derived from hepatic tissue but may lead to a misinterpretation as a malignant lesion. Nevertheless biliary duct adenomas are benign lesions with almost the same perfusion properties as normal liver parenchyma. Therefore, while using SonoVue, such a misinterpretation of these very common but in most cases very small and not detectable lesions seems unlikely.
Hohmann
J
J
Department of Radiology, University Hospital Basel, Petersgraben 4, Basel. jhohmann@uhbs.ch
Loddenkemper
C
C
Albrecht
T
T
D002759:Adenoma, Bile Duct / Q000000981:diagnostic imaging* / Q000473:pathology; D001649:Bile Duct Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging* / Q000473:pathology; D044963:Biopsy, Fine-Needle; D003287:Contrast Media; D003937:Diagnosis, Differential; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D006222:Hamartoma / Q000000981:diagnostic imaging*; D006801:Humans; D033162:Incidental Findings; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010743:Phospholipids; D011134:Polysaccharides; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D018616:Ultrasonography, Doppler, Duplex
D003287:Contrast Media; D010743:Phospholipids; D011134:Polysaccharides; C420843:contrast agent BR1; C059891:SHU 508; D013459:Sulfur Hexafluoride