A 39-year-old woman undergoes abdominal ultrasound for evaluation of right upper quadrant discomfort. An incidental 2.4-cm lesion is found in segment VII of the right lobe. The structure marked **A** in the diagram shows a homogeneously hyperechoic subcapsular lesion with sharp non-infiltrating margins and posterior acoustic enhancement, with no internal vascularity on colour Doppler. Based on these imaging features, what is the most likely diagnosis?

Why Hepatic cavernous haemangioma is right

The combination of a homogeneously hyperechoic lesion (marked A) with sharp non-infiltrating margins, posterior acoustic enhancement, and absence of internal vascularity on colour Doppler is the classic ultrasound signature of a small hepatic cavernous haemangioma. This benign vascular lesion is the most common benign liver tumour and requires no follow-up or intervention when incidentally discovered in a patient without risk factors for malignancy, as described in AIIMS Radiology Review — Focal Liver Lesions, 2nd ed. The hyperechoic appearance reflects the blood-filled cavernous spaces; the posterior enhancement occurs because ultrasound passes through the fluid-filled lesion with minimal attenuation.

Why each distractor is wrong

AIIMS Radiology Review — Focal Liver Lesions, 2nd ed.