Hepatic Tumors

How to Cite This Chapter: Essaji Y, Krawczyk M, Patkowski W. Hepatic Tumors. McMaster Textbook of Internal Medicine. Kraków: Medycyna Praktyczna. https://empendium.com/mcmtextbook/chapter/B31.II.7.30.4. Accessed July 22, 2024.
Last Updated: October 13, 2022
Last Reviewed: October 13, 2022
Chapter Information


Table 7.3-1. Ultrasound and CT characteristics of hepatic tumors





Hemangiomas sized <3 cm in diameter are visible as oval, hyperechoic, and well-defined structures in the liver parenchyma; larger hemangiomas usually have heterogeneous echostructure; little or no signal is observed on Doppler examination (very slow blood flow)

On plain CT scan hemangioma is visible as a hypodense, oval, well-demarcated and uniform lesion with a centripetal (inward) fill-in after contrast administration; small lesions (<3 cm) may show uniform or centrifugal enhancement (from the center outwards)


Hypo- or hyperechoic lesion, hypervascular in the arterial phase on Doppler examination, (unlike hepatocellular adenoma, for which the venous signal is characteristic)

Before contrast administration the tumor is hypo- or isodense; after rapid contrast injection, an arterial vessel is visible within the central fibrous scar in the arterial phase; characteristic fibrous septa and central scar are usually visible in lesions >3 cm

Hepatocellular adenoma

Hypo-, hyper-, or iso-echoic lesion with a predilection for subcapsular regions of the right lobe; the image is often heterogeneous and can have visible calcifications inside; may be surrounded by a hypoechoic zone; in 40%-60% of cases the lesion is hypervascular in the arterial phase on Doppler examination, but to a lesser extent than in FNH, and shows centripetal filling (opposite to FNH, which shows centrifugal filling)

Hemorrhagic changes are visible as hyperdense foci; the lesion shows rapid centripetal post-contrast filling in the early arterial phase and becomes isodense again in the portal phase

Hepatocellular carcinoma

Iso-, hypo-, or hyperechoic tumor; often heterogeneous; with a characteristic hypoechoic rim with clearly pronounced [post-contrast] enhancement; sometimes signs of portal vein thrombosis

The lesion is hypodense and heterogeneous on plain CT with density increasing nonuniformly following contrast administration in the arterial phase; use the LI-RADS criteria for imaging diagnosis

Simple cyst

Anechoic, homogeneous lesion filled with fluid, with smooth margins

A well-defined, smooth lesion with water density, no internal structure, not enhancing after contrast administration

Polycystic liver disease

Numerous simple cyst–like sacs

Numerous simple cyst–like sacs

Echinococcal cyst


– Initially similar to simple cysts

– Thick, calcified walls with hyper- or hypoechoic contents gradually develop

– Daughter cysts may be seen peripherally

– Hypodense lesion with a highly vascularized wall and internal cysts

– Calcified walls and septa

– Daughter cysts visible peripherally

CT, computed tomography; FNH, focal nodular hyperplasia; LI-RADS, Liver Imaging Reporting and Data System.

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