Focal hyperechoic liver lesions in children: far beyond hemangiomas - pictorial essay

The aim of this report was to present a selection of focal hyperechoic liver lesions of different etiologies, illustrating the wide spectrum of diagnostic possibilities for such lesions in the pediatric population.

Keywords:
Liver/diagnostic imaging; Ultrasonography; Liver neoplasms/diagnosis; Diagnosis, differential; Infant; Child; Adolescent

Authorship

Silvia Maria Sucena da Rocha Correspondence: Dra. Silvia Maria Sucena da Rocha. Serviço de Apoio Diagnóstico e Terapêutico (SADT), ICr/HC-FMUSP. Avenida Doutor Enéas de Carvalho Aguiar, 647, 2º andar, Cerqueira César. São Paulo, SP, Brazil, 05403-901. Email: smsucena@uol.com.br.

Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICr/HC-FMUSP), São Paulo, SP, Brazil.Universidade de São PauloBrazilSão Paulo, SP, BrazilInstituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (ICr/HC-FMUSP), São Paulo, SP, Brazil.

Centro Diagnóstico do Laboratório Fleury Medicina e Saúde, São Paulo, SP, Brazil.Laboratório Fleury Medicina e SaúdeBrazilSão Paulo, SP, BrazilCentro Diagnóstico do Laboratório Fleury Medicina e Saúde, São Paulo, SP, Brazil.

http://orcid.org/0000-0001-8640-4900

Maurício Gustavo Ieiri Yamanari

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.Hospital Israelita Albert EinsteinBrazilSão Paulo, SP, BrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.

http://orcid.org/0000-0002-8394-8029

Marcia Wang Matsuoka

http://orcid.org/0000-0001-6856-0512

Gisele Correa Almeida

http://orcid.org/0000-0003-2175-5827

Flavia Aiko Sakamoto

http://orcid.org/0000-0002-0806-512X

Lisa Suzuki

Centro de Diagnósticos do Hospital Infantil Sabará, São Paulo, SP, Brazil.Hospital Infantil SabaráBrazilSão Paulo, SP, BrazilCentro de Diagnósticos do Hospital Infantil Sabará, São Paulo, SP, Brazil.

http://orcid.org/0000-0001-6045-0191

Correspondence: Dra. Silvia Maria Sucena da Rocha. Serviço de Apoio Diagnóstico e Terapêutico (SADT), ICr/HC-FMUSP. Avenida Doutor Enéas de Carvalho Aguiar, 647, 2º andar, Cerqueira César. São Paulo, SP, Brazil, 05403-901. Email: smsucena@uol.com.br.

SCIMAGO INSTITUTIONS RANKINGS

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.Hospital Israelita Albert EinsteinBrazilSão Paulo, SP, BrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.

Figures

Figures (9)

Thumbnail

Figure 1
Childhood hepatic hemangioma-diffuse lesions in a 6-month-old girl. A: B-mode ultrasound shows multiple diffusely distributed hyperechoic liver nodules, some with small cystic areas. B: Color Doppler study showing a diffuse increase in hepatic vascularization.

Thumbnail

Figure 2
Congenital hepatic arteriovenous malformation in a 4-year-old girl with hereditary hemorrhagic telangiectasia who presented with complex hepatic vascular malformation. A: B-mode ultrasound shows subcapsular hyperechoic focal lesion (telangiectasia). B: Doppler ultrasound showing tortuous large vessels towards the lesion. C: Spectral ultrasound analysis showing turbulent flow at high velocity. Signs of portal hypertension, such as reversal of the portal venous flow and collateral circulation, were present at diagnosis (images not included).

Thumbnail

Figure 3
Hematoma as a complication of misplaced umbilical catheter. Ultrasound examinations of three different newborns, at two, four, and six weeks of age, respectively, showing hyperechoic focal lesions with irregular borders. In A, there is a liquid component in the center of the lesion. In C, the lesion is elongated (arrows), probably representing the path of the catheter that transfixed the hepatic parenchyma.

Thumbnail

Figure 4
Hepatoblastoma in a 4-year-old girl. Doppler ultrasound showing a heterogeneous, slightly hyperechoic mass, containing tiny cystic foci, that displaces the hepatic veins. Pathology result of the surgical specimen obtained by resection of the hepatoblastoma.

Thumbnail

Figure 5
Multifocal nodular subcapsular hepatic steatosis in an 8-year-old boy with chronic liver disease and cystic fibrosis. Follow-up ultrasound showing diffuse heterogeneity of the liver parenchyma and subcapsular hyperechoic multifocal lesions, some with a nodular appearance (arrows), without causing a mass effect.

Thumbnail

Figure 6
Hepatic lipoma in a 15-year-old female with tuberous sclerosis. A: Ultrasound of the liver, showing a hyperechoic circumscribed nodular lesion (arrow). B: T2-weighted magnetic resonance imaging sequence showing a small, round lesion with a clearly hyperintense signal (arrow) and evident signal loss following fat suppression (arrow in C), behavior similar to that of subcutaneous tissue, proving that the lesion had a fat component and confirming the diagnosis of lipoma.

Thumbnail

Figure 7
Biliary rhabdomyosarcoma in a 4-year-old girl with a three-week history of jaundice, acholic stools, abdominal pain, and pruritus, who was referred for investigation of a suspected cyst in the common bile duct. A: Doppler ultrasound of the abdomen, showing a hyperechoic solid liver lesion with central and peripheral vascularization. B,C: Lesion in the lumen of the common bile duct (longitudinal and transverse sections, respectively), occupying and significantly increasing its caliber (arrows).The lesion is solid and hyperechoic, containing cystic foci. The image in C also shows the obstructive effect produced by the lesion with repercussions for the pancreatic duct, the caliber of which is slightly increased. The mass was surgically resected, and the pathology study indicated biliary rhabdomyosarcoma with hepatic invasion.

Thumbnail

Figure 8
Liver regeneration nodule in a 3-month-old girl diagnosed with biliary atresia. Abdominal ultrasound with convex and linear transducers (A and B, respectively), showing a large, well-defined hyperechoic nodule in the left hepatic lobe. The image in B shows that there is no vascular distortion, and a portal branch can be seen within the lesion. Surgical resection was performed, and the pathology study indicated a regeneration nodule.

Thumbnail

Figure 9
Biliary hamartomas in an otherwise healthy 2-month-old boy. Abdominal ultrasound showing multiple sparse hyperechoic foci along the biliary tract. Note that some foci produce the “comet tail” artifact, characteristic of cholesterol crystals, whereas others produce posterior acoustic shadowing, possibly corresponding to calcifications.

Figure 1 Childhood hepatic hemangioma-diffuse lesions in a 6-month-old girl. A: B-mode ultrasound shows multiple diffusely distributed hyperechoic liver nodules, some with small cystic areas. B: Color Doppler study showing a diffuse increase in hepatic vascularization.

Figure 2 Congenital hepatic arteriovenous malformation in a 4-year-old girl with hereditary hemorrhagic telangiectasia who presented with complex hepatic vascular malformation. A: B-mode ultrasound shows subcapsular hyperechoic focal lesion (telangiectasia). B: Doppler ultrasound showing tortuous large vessels towards the lesion. C: Spectral ultrasound analysis showing turbulent flow at high velocity. Signs of portal hypertension, such as reversal of the portal venous flow and collateral circulation, were present at diagnosis (images not included).

Figure 3 Hematoma as a complication of misplaced umbilical catheter. Ultrasound examinations of three different newborns, at two, four, and six weeks of age, respectively, showing hyperechoic focal lesions with irregular borders. In A, there is a liquid component in the center of the lesion. In C, the lesion is elongated (arrows), probably representing the path of the catheter that transfixed the hepatic parenchyma.

Figure 4 Hepatoblastoma in a 4-year-old girl. Doppler ultrasound showing a heterogeneous, slightly hyperechoic mass, containing tiny cystic foci, that displaces the hepatic veins. Pathology result of the surgical specimen obtained by resection of the hepatoblastoma.

Figure 5 Multifocal nodular subcapsular hepatic steatosis in an 8-year-old boy with chronic liver disease and cystic fibrosis. Follow-up ultrasound showing diffuse heterogeneity of the liver parenchyma and subcapsular hyperechoic multifocal lesions, some with a nodular appearance (arrows), without causing a mass effect.

Figure 6 Hepatic lipoma in a 15-year-old female with tuberous sclerosis. A: Ultrasound of the liver, showing a hyperechoic circumscribed nodular lesion (arrow). B: T2-weighted magnetic resonance imaging sequence showing a small, round lesion with a clearly hyperintense signal (arrow) and evident signal loss following fat suppression (arrow in C), behavior similar to that of subcutaneous tissue, proving that the lesion had a fat component and confirming the diagnosis of lipoma.

Figure 7 Biliary rhabdomyosarcoma in a 4-year-old girl with a three-week history of jaundice, acholic stools, abdominal pain, and pruritus, who was referred for investigation of a suspected cyst in the common bile duct. A: Doppler ultrasound of the abdomen, showing a hyperechoic solid liver lesion with central and peripheral vascularization. B,C: Lesion in the lumen of the common bile duct (longitudinal and transverse sections, respectively), occupying and significantly increasing its caliber (arrows).The lesion is solid and hyperechoic, containing cystic foci. The image in C also shows the obstructive effect produced by the lesion with repercussions for the pancreatic duct, the caliber of which is slightly increased. The mass was surgically resected, and the pathology study indicated biliary rhabdomyosarcoma with hepatic invasion.

Figure 8 Liver regeneration nodule in a 3-month-old girl diagnosed with biliary atresia. Abdominal ultrasound with convex and linear transducers (A and B, respectively), showing a large, well-defined hyperechoic nodule in the left hepatic lobe. The image in B shows that there is no vascular distortion, and a portal branch can be seen within the lesion. Surgical resection was performed, and the pathology study indicated a regeneration nodule.

Figure 9 Biliary hamartomas in an otherwise healthy 2-month-old boy. Abdominal ultrasound showing multiple sparse hyperechoic foci along the biliary tract. Note that some foci produce the “comet tail” artifact, characteristic of cholesterol crystals, whereas others produce posterior acoustic shadowing, possibly corresponding to calcifications.

How to cite

copy

Publicação do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem Av. Paulista, 37 - 7º andar - conjunto 71, 01311-902 - São Paulo - SP, Tel.: +55 11 3372-4541, Fax: 3285-1690, Fax: +55 11 3285-1690 - São Paulo - SP - Brazil
E-mail: radiologiabrasileira@cbr.org.br

Acompanhe os números deste periódico no seu leitor de RSS

Versão para download de PDF

PDF

Inglês
Português

Versões e tradução automática

Versão original do texto

English
Português

Tradução automática

Google Translator
Microsoft Translator

Como citar

RIS

BIBTEX

Outros formatos de citação e exportação:

SciELO - Scientific Electronic Library Online
Rua Dr. Diogo de Faria, 1087 – 9º andar – Vila Clementino 04037-003 São Paulo/SP - Brasil
E-mail: scielo@scielo.org

Leia a Declaração de Acesso Aberto

Métricas

Focal hyperechoic liver lesions in children: far beyond hemangiomas - pictorial essay

PlumX

Mensagem

[1] Correspondence: Dra. Silvia Maria Sucena da Rocha. Serviço de Apoio Diagnóstico e Terapêutico (SADT), ICr/HC-FMUSP. Avenida Doutor Enéas de Carvalho Aguiar, 647, 2º andar, Cerqueira César. São Paulo, SP, Brazil, 05403-901. Email: smsucena@uol.com.br.