On ultrasound of the liver, an echogenic mass with posterior acoustic shadowing and absence of vascularity on Doppler is most consistent with:

• A Haemangioma
• B Hepatocellular carcinoma
• C Calcified hepatic metastasis ✓
• D Simple hepatic cyst

Explanation

Posterior acoustic shadowing behind an echogenic hepatic mass indicates calcification, which is characteristic of calcified hepatic metastasis (most commonly from colorectal, gastric, mucinous, or treated lesions). The calcification causes acoustic impedance mismatch, resulting in near-complete reflection of the beam and posterior shadowing. Haemangiomas are typically echogenic with no posterior shadowing and show peripheral nodular enhancement. HCC in cirrhosis shows varied echogenicity, arterial flow on Doppler, and no shadowing. Simple cysts are anechoic with posterior acoustic enhancement (not shadowing).

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.