Fig. 4. A 52-year-old man with past history of medullary thyroid carcinoma and liver metastasis.

Notice a hypoechoic nodule by B-mode ultrasonography (delimited by calipers in A [axial oblique plane] and B [longitudinal plane]), measuring 1.1×1.1×0.9 cm in segment VII. After contrast-enhanced ultrasonography, the nodule presents peripheral arterial hyperenhancement (rim arterial phase hyperenhancement, arrow in C), hyperenhancement (D), and early washout (still in the arterial phase, before the portal and late phase) (E, F). The arrows point to the same nodule (C-F) evaluation over time after contrast injection. The portal venous phase after CEUS can be seen (G, H) and the late phase is characterized 3.41 minutes after contrast injection (I). With contrast-enhanced ultrasonography, it is possible to identify several small nodules (pointed out with arrows) distributed in the liver with early washout. After the portal phase, it is possible to observe additional nodules not seen in the conventional base ultrasound.