Abstract
A woman in her seventies, who was suspected of acute hepatitis or acute cholangitis and tumor of pulmonary hilar lesion at another hospital, was referred to our hospital for detailed examination and treatment. Laboratory examination showed mild anemia, high hepatobiliary enzyme levels, and mild inflammatory findings. On B-mode US, the liver was markedly swollen at both lobes, with low to isoechoic tumors with halo in the liver parenchyma near the surface. Contrast-enhanced ultrasonography (post-vascular phase) observation with a convex probe revealed a large number of defects up to 8 mm in size in the liver. Furthermore, contrast-enhanced ultrasonography (post-vascular phase) observation of with a linear probe revealed innumerable minute defects in the liver. Tumor markers NSE and ProGRP were 562.0 ng/mL and 36,325.4 pg/mL, respectively. Mediastinal lymph nodes were punctured using bronchoscopy. Fine-needle aspiration cytology revealed lymph node metastasis from small cell lung cancer. By using contrast-enhanced ultrasonography (post-vascular phase) with a linear probe, we could detect innumerable minute defects in the liver that were unclear with a convex probe. They were diagnosed as diffuse liver metastasis from small cell lung cancer based on the assessment of tumor markers. In cases with an unknown liver disorder, if a malignant disease is suspected and we can detect hepatomegaly or liver tumor on B-mode US, it is necessary to distinguish diffuse liver metastasis. The suggestion of CEUS examination from the examiner to the physician could help early diagnosis of diffuse liver metastasis.
