Which ultrasound appearance is typical of metastatic liver disease?

• A. Hypoechoic ring, irregular shape, heterogenous
• B. A simple cyst
• C. A well-defined hyperechoic mass
• D. A completely anechoic lesion

Answer: (A)

Metastatic liver nodules tend to be solid, irregular in outline, and show heterogeneous internal echoes due to necrosis or varied tissue characteristics. The typical appearance described as a hypoechoic ring with an irregular shape and heterogeneous contents reflects that the lesion is not a simple fluid-filled cyst and not a uniformly solid mass. Multiple lesions are common, and their borders are often not smooth, which contrasts with other options.

A simple cyst is completely anechoic with well-defined, smooth borders and posterior acoustic enhancement, not a solid, irregular, heterogeneous mass. A well-defined hyperechoic mass could describe benign lesions like hemangiomas or fat-containing lesions, but metastases are not usually purely hyperechoic or well circumscribed. A completely anechoic lesion points to a cyst, not metastasis.

So, the combination of a lesion that is hypoechoic with irregular shape and heterogeneous interior best fits the typical ultrasound appearance of metastatic liver disease.