General Ultrasound

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35 year old female, vague abdominal pain

further recommended studies, if any?

Additional Imaging (different patient)

Contrasted CT, 120 s Delay
Same study, 300 s Delay

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Final Dx?
Hepatic Hemangiomas
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Ultrasound shows multiple homogeneous, hyperechoic hepatic masses: DDx hemangioma vs. more malignant process

Dynamic CT scanning (in a different patient) shows a well-circumscribed, hypoattenuating lesion that completely fills-in at 5 min

Hepatic Hemangioma – MRI Correlation


T2-weighted MRI:
Well-defined lesion, brighter than spleen
T1-Gad, at 30 s:
Nodular enhancement at periphery
T1 –Gad, AT 5 MIN:
Most of lesion has enhanced

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Appearance of hemangiomas on US is characteristic but not pathognomonic

DDx includes Hemangioma, Mets, HCC, and nodular fat

Some feel patients at low risk for malignancy require no f/u, but at the least, 6-mo f/u US to evaluate stability is prudent. Nucs / CT /MRI can confirm. Most common benign livertumor, rarely symptomatic, typically no flow by US

Kasabach-Merritt syndrome: liver hemangiomas + platelet sequestration

Biopsy OK if there is normal liver between lesion and liver capsule

These signals are relayed buying clomid online safe which then is by a number of such as medial preoptic and paraventricular nulcei.