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British Journal of Radiology (2005) 78, 956-960
© 2005 British Institute of Radiology
doi: 10.1259/bjr/27365821
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Hepatic angiomyolipoma: identification of an efferent vessel to be hepatic vein by contrast-enhanced harmonic ultrasound

R Q Zheng, MD, PhD1 and M Kudo, MD, PhD2

1 Department of Ultrasound, the Third Affiliated Hospital, Sun Yat-sen University, Shipai, Guangzhou 510630, China and 2 Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-Sayama, Japan




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  		Figure 1. 43-year-old woman with a histology-proven hepatic angiomyolipoma. (a) Fundamental B-mode ultrasound (US) revealed a heterogeneous hypoechoic nodule mixed with hyperechoic areas in the medial segment of the liver (arrows). The lesion was irregular in shape with ill-defined margin. After Levovist administration using Coded Harmonic Angio mode, (b) tumour vessels, including the feeding vessel (arrows), were demonstrated in the early arterial phase. During the late vascular phase, (c) tumour parenchymal stain of the whole nodule was apparent (arrow). (d) An efferent vessel appeared in the inferior margin of the tumour (arrow) and (e, f) continued to a hepatic vein during dynamic assessment (arrows). ) (g) Digital subtraction angiography in the venous phase showed the dense stain of the nodule and the efferent vessel, which was the hepatic vein (arrows). In addition, multiple small haemangiomas were also shown. (h) The cut surface of the ill defined tumour was yellowish mixed with white colour tissue and dark haemorrhage clot. (i) On histological section, a small thick-walled vessel (arrows) surrounded by proliferated tumour cells was seen.

 


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  		Figure 2. 49-year-old woman with a histology-proven hepatic angiomyolipoma. (a) Contrast-enhanced harmonic power Doppler ultrasound revealed a hypervascular mass with strong tumour parenchymal stain in the posterior superior segment of the right liver lobe. An efferent vessel that ran from inside the tumour via the right hepatic vein to the direction of inferior vena cava (IVC) was seen (arrow). (b) On CT during angiography, a hyperdense mass with afferent (white arrow) and efferent (black arrow) vessels was clearly demonstrated. The efferent vessel was the hepatic vein that flowed from the tumour into the IVC through right hepatic vein, consistent with the finding revealed by contrast-enhanced harmonic power Doppler.

 




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