Clinical Journal of Gastroenterology

, Volume 11, Issue 6, pp 514–520 | Cite as

Utility of contrast-enhanced ultrasonography with perflubutane in evaluating indications for diagnostic percutaneous tumor biopsy in a case of hepatic sclerosed hemangioma

  • Yusuke Ando
  • Masatoshi IshigamiEmail author
  • Yoji Ishizu
  • Teiji Kuzuya
  • Takashi Honda
  • Yoshiki Hirooka
Case Report


Sclerosed hemangioma is difficult to distinguish from intrahepatic cholangiocarcinoma or liver metastasis due to their imaging resemblance, thus pathological diagnosis is often required; however, percutaneous biopsy entails a risk of dissemination if the tumor is malignant. Perflubutane, a contrast agent of ultrasonography, has a characteristic feature of being phagocytosed by Kupffer cells. Hepatic malignant lesions contain few or no Kupffer cells, therefore, they are shown as a contrast defect. We report a case in which contrast enhanced ultrasonography (CEUS) with perflubutane was useful to evaluate indications for percutaneous tumor biopsy. A 69-year-old woman had a hypoattenuating mass with slight enhancement in peripheral lesion of the tumor in the arterial phase on dynamic computed tomography. From the arterial phase to the delayed phase, the hypoattenuating area was gradually and slightly enhanced, and peripheral enhancement also increased gradually, appearing as ring enhancement. We considered intrahepatic cholangiocarcinoma, liver metastasis, and sclerosed hemangioma as differential diagnoses. Most of the tumor did not display contrast defects in the post-vascular phase on CEUS, therefore, we considered the possibility of malignancy was low and performed percutaneous biopsy. The tumor was diagnosed as sclerosed hemangioma. CEUS may be useful in evaluating indications for diagnostic percutaneous tumor biopsy.


Sclerosed hemangioma Contrast enhanced ultrasonography Biopsy 


Compliance with ethical standards

Conflict of interest

Yusuke Ando and the co-authors declare that they have no conflict of interest.

Human/animal rights

All human studies have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its subsequent amendments.

Informed consent

Informed consent was obtained from the patient for being included in the study.


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Copyright information

© Japanese Society of Gastroenterology 2018

Authors and Affiliations

  • Yusuke Ando
    • 1
  • Masatoshi Ishigami
    • 1
    Email author
  • Yoji Ishizu
    • 1
  • Teiji Kuzuya
    • 1
  • Takashi Honda
    • 1
  • Yoshiki Hirooka
    • 1
  1. 1.Department of Gastroenterology and HepatologyNagoya University Graduate School of MedicineNagoyaJapan

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