Symptoms of chronic nausea/vomiting, unintended weight loss (20+ pounds over one month), chronic right upper abdomen pain.
Radiology report as follows:
There is no evidence of cholelithiasis. The common bile duct measures 4 to 5 mm in AP diameter. There is no evidence of dilated intrahepatic biliary radicles. A homogeneous liver parenchymal pattern is demonstrated. Within the right hepatic lobe are 3 well-defined echogenic lesions. The largest is seen within the lateral mid lobe measuring 5.1 x 3.7 x 2.6 cm color Doppler evaluation suggests a minimal amount of peripheral associated vascularity. Another within the anterior right lobe measures up to 7 mm in diameter and a third within the posterior mid lobe measures up to 1.4 cm in diameter. These likely represent hemangiomas. An additional mildly hypoechoic mass is seen within the inferior, lateral left lobe measuring 3.4 x 2.0 x 2.9 cm in diameter. Color Doppler evaluation demonstrates significant peripheral vascularity. This lesion does not have sonographic typical characteristics of a hemangioma. The spleen measures 13.5 cm in greatest length. Screening images of the kidneys demonstrate no evidence of hydronephrosis. The right kidney measures 10.2 cm in length and the left kidney measures 11.5 cm in length. There is no evidence of pancreatic enlargement or focal masses within the pancreatic bed. No free intraperitoneal fluid is identified. Visualized portions of the abdominal aorta demonstrate no evidence of aneurysmal dilatation. Visualized portions the IVC appear normal. Limited evaluation of the main portal vein demonstrates hepatopetal flow.
1. Findings that likely represent 3 hemangiomas within the right hepatic lobe. A fourth lesion within the left hepatic lobe does not have sonographic characteristics that are typical of a hemangioma. Computed tomography with contrast or an MRI study is suggested for better characterization if these have not been previously performed.
2. No evidence of cholecystolithiasis or biliary obstruction.
3. Mild splenomegaly.
What could the hypoechoic mass be?