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DOI: 10.1055/a-1005-7459
The ‘Disappearing’ Liver on CEUS: Nothing to Worry About
Publication History
Publication Date:
26 September 2019 (online)
Case Presentation
A 72-year-old female patient was referred to our US department for contrast-enhanced ultrasound (CEUS) due to rectal cancer and focal liver lesions. In addition, she was suffering from chronic left heart failure (NYHA III) due to combined aortic valve disease and coronary heart disease. The patient’s liver was examined using a Hitachi Ascendus US machine in low MI mode. She received 2.4 ml of immediately prepared SonoVue® (Bracco Imaging) intravenously, followed by 10 ml of saline solution. The known liver lesions were diagnosed as hemangiomas.
Starting about 150 seconds after the administration of SonoVue®, hyperechoic spots emerged all over the liver, starting in the periportal regions ([Fig. 1]), subsequently growing together to form cloud-like “lesions” ([Fig. 2]). The visibility of the liver in grayscale decreased significantly and the liver parenchyma was not visible at all 3 min after the injection. The image was the same 1 h later. Changing from low to high MI mode did not improve the visibility of the liver parenchyma ([Fig 3]).
The patient was completely free of discomfort the entire time and her liver enzymes remained in the normal range. An ultrasound examination four weeks later depicted a regular liver parenchyma.