Sonographic pattern of a von Meyenburg complex

Objectives: Presentation of a baseline gray-scale sonogram and the perfusion pattern in contrast-enhanced ultrasound of a histological proven von Meyenburg complex.

Methods: A 66 year old female underwent ultrasound as follow-up measure after resection of a cyst adenoma of the pancreatic tail in 2001. A hyper echoic lesion (diameter 4cm) surrounded by a halo was described in the left hepatic lobe. Contrast-enhanced sonography with a low mechanical index (<0.2) was performed. Scanning was continued up to five minutes.

Results: A diffuse hyper vascularisation was observed after 10s up to 120s. Then the hyper vascularisation disappeared and the lesion was not distinguishable any more from the surrounding liver tissue. Differential diagnosis was broad. Histology was obtained twice and revealed a fibrosing process in normal liver tissue with cystic areas surrounded by epithelial cells containing fluid in both biopsies. Zytokeratin 7 was positive. The diagnosis of a von Meyenburg complex was established. An association between multiple and unusually large von Meyenburg complexes and hepatocellular carcinoma and cholangiocarcinoma has been described in the literature. Therefore, surgery was recommended, but the patient refused. Control contrast ultrasound after 3 months demonstrated an identical lesion with the same dimensions and an unchanged contrast pattern.

Conclusion: Von Meyenburg complexes may present hyper echoic in gray-scale sonogram and hyperperfused in the early phase of contrast-enhanced sonography with a low mechanical index.