Contrast-enhanced ultrasound manifestations of synchronous combined hepatocellular-cholangiocarcinoma and hepatocellular carcinoma: A case report

Figure 1 Contrast enhanced computed tomography and ultrasound images of a liver lesion in S4. A: A slightly low-density nodule measuring 2.1 cm × 2.0 cm was detected in liver S4 (A, arrow) on unenhanced computed tomography; B and C: The nodule showed marked enhancement in the arterial phase (B, arrow) followed by isoenhancement in the portal venous phase (C, arrow); D and E: The nodule presented a hypoechoic lesion with a clear boundary and regular shape (D, arrow) on conventional ultrasound; the color Doppler showed punctate blood flow signal (E, arrow) in the peripheral area of the lesion; F-H: On contrast enhaned ultrasound, the lesion manefested homogeneous hyperenhancement (F, arrow), followed by mild hyperenhancement in the portal venous phase (G, arrow) and hypoenhancement in the late phase (H, arrow); I: Postoperative pathology confirmed this lesion as being a poorly differentiated hepatocellular carcinoma (hematoxylin-eosin staining).