US Quiz of the Month – December 2016


We present the case of a 70-year-old woman with no relevant history to whom an upper endoscopy was performed due to dyspeptic complaints. During the examination, an apparent subepithelial lesion with approximately 30 mm located in the gastric fundus was observed.

Figure 1. Nodular lesion with normal underlying mucosa in the gastric fundus.


For additional assessment, we performed a hydrogastric sonography (HGS). The examination was executed after the ingestion of 400 mL of water. HGS demonstrated a hyperechoic nodule located in the periphery of the left hepatic lobe with 27 mm of bigger axis, compatible with an hepatic hemangioma. As the lesion was exophytic, it compressed the stomach wall, mimicking a subepithelial lesion.


Figure 2. HGS clearly demonstrating the liver hemangioma compressing the stomach wall. (F – liver; H – hemangioma; EST – stomach filled with water).



Hepatic hemangiomas are the most common liver benign tumors, typically presenting as a homogenous, hyperechoic nodule with well-defined margins on ultrasonography. Exophytic forms of hepatic hemangiomas are very rare . Endoscopic ultrasound (EUS) is currently the gold standard in the evaluation of subepithelial lesions of the gastrointestinal tract, allowing the differentiation of extramural compression from intramural growth, the determination of layer of origin, regional lymphadenopathy and the acquisition of tissue for anatomopathologic diagnosis . However, EUS is an invasive procedure with a risk of complications. HGS is a modification of transabdominal ultrasound, with the advantages of being widely available, non-invasive and with no major costs when compared with EUS. This case adds to the existing evidence of the value of HGS in the diagnosis of submucosal lesions and extrinsic compressions of the gastric wall .



1. Moon HK, Kim HS, Heo GM et al. A case of pedunculated hepatic hemangioma mimicking submucosal tumor of the stomach. The Korean journal of hepatology 2011; 17: 66-70

2. Menon L, Buscaglia JM. Endoscopic approach to subepithelial lesions. Therapeutic Advances in Gastroenterology 2014; 7: 123-130

3. Segura Cabral JM, Conde Gacho P, Comas Redondo C et al. . Gastroenterologia y hepatologia 1999; 22: 63-66


Paula Sousa1, Tiago Capela2, João Pinto3, Ana Caldeira3, Eduardo Pereira3, António Banhudo3

1. Gastroenterology department – Centro Hospitalar Tondela-Viseu

2. Gastroenterology department – Hospital Santo António dos Capuchos, Centro Hospitalar Lisboa Central

3. Gastroenterology department – Hospital Amato Lusitano