Morphological Type | Differentials | Distinguishing feature(s) |
---|---|---|
Solitary discrete lesion | Cyst | - Posterior acoustic enhancement on US |
Abscess | - Mobile internal echoes, septations and heterogeneity on US - Reactive right pleural effusion, ascites and caecal wall thickening - Presence of surrounding edema and pylephlebitis - Absence of vessel penetration sign | |
Hepatocellular carcinoma (HCC) | - Arterial phase enhancement - Venous invasion/thrombosis - Raised alpha-fetoprotein levels | |
Focal nodular hyperplasia | - Homogeneous enhancement | |
Intrahepatic cholangiocarcinoma | - Capsular retraction - Mass effect in the form of biliary dilatation and vascular displacement - Increased CA-19.9 levels | |
Multifocal lesions | Tuberculosis | - Necrotic rim-enhancing lymph nodes - Lung parenchymal involvement |
Sarcoidosis | -T2-hypointense nodules - Pulmonary involvement - Hilar lymphadenopathy | |
Fungal microabscesses | - Perilesional edema - History of immunosuppression - High-grade fever with increased white blood cell count | |
Septic emboli | - Known source of infection - Clinical features of sepsis | |
Metastases | - Known primary malignancy | |
Diffuse infiltration | Infiltrative HCC | - Venous invasion/thrombosis - Markedly raised alpha-fetoprotein levels - Often non-avid on FDG PET-CT |
Acute viral hepatitis | - Echogenic periportal cuffing on US - Normal or mildly elevated LDH levels - Significant elevation of transaminases | |
Periportal mass | Periportal edema | - Echogenic on US - History of trauma, surgery |
Biliary dilatation | - Anechoic tubular structures on US - Absence of complete encasement of portal venous radicals |