Differential Diagnosis for Hyperechoic Hepatic Mass

• Single most likely diagnosis
  • Hemangioma: This is the most common benign liver lesion, and its appearance on ultrasound as a hyperechoic mass with no internal flow on color Doppler is consistent with this diagnosis. Hemangiomas are typically well-circumscribed and can be found in the right hepatic lobe.
• Other Likely diagnoses
  • Focal fatty change or fatty sparing: These conditions can appear as hyperechoic areas on ultrasound due to the difference in echogenicity between the fatty and non-fatty liver tissue. However, they usually do not form distinct masses and can be differentiated by their characteristic locations and patterns.
  • Hepatic adenoma: Although less common, hepatic adenomas can appear hyperechoic on ultrasound. They might show some internal vascularity, but small adenomas could potentially have minimal detectable flow.
• Do Not Miss diagnoses
  • Hepatocellular carcinoma (HCC): While less likely given the small size and lack of internal flow, HCC is a critical diagnosis not to miss due to its potential for malignancy. Small HCCs can be hyperechoic and may not always show significant vascularity on color Doppler.
  • Metastasis: Metastatic lesions to the liver can have a variable appearance, including being hyperechoic. The absence of internal flow does not rule out metastasis, especially if the primary cancer is known to metastasize to the liver.
• Rare diagnoses
  • Biliary hamartoma (von Meyenburg complex): These are rare, benign lesions that can appear as small, hyperechoic masses on ultrasound. They are usually multiple and can be associated with polycystic liver disease.
  • Inflammatory pseudotumor: This is a rare lesion that can mimic a neoplasm on imaging. It might appear hyperechoic on ultrasound, but its appearance can be variable, and diagnosis often requires histological confirmation.
  • Peliosis hepatis: A rare condition characterized by the presence of blood-filled cavities within the liver. It can appear as hyperechoic masses on ultrasound, but it's more commonly associated with other clinical findings and conditions.