Home WIOTM Case of the Month March – The Northern Lights CEUS Artifact

Case of the Month March – The Northern Lights CEUS Artifact

by Admin

The Northern Lights CEUS Artifact

By Christian Pallson Nolsøe, MD, PhD
Zealand University Hospital, Køge, Department of Surgery

Clinical History:

A 66-year-old male with a history of colon cancer was referred for US-guided biopsy to confirm small PET-positive liver-lesions suspicious of colorectal liver metastases. However, B-mode ultrasound imaging could not visualize the lesions why a Contrast-enhanced ultrasound (CEUS) study using Sonazoid was performed.

CEUS clearly demonstrated wash out of several small lesions, and a CEUS-guided biopsy was carried out at 8 minutes after contrast injection. Immediately after the procedure a strange phenomenon was seen on the B-mode image.

Figure 1. CEUS-guided biopsy of B-mode invisible lesions (white arrows) with distinctive wash out on Sonazoid study. The biopsy target is seen in the puncture line in the upper right image corner.
Figure 2. “Northern Lights” phenomenon (red arrows) was seen on B-mode scanning immediately after Sonazoid guided biopsy. This is also demonstrated in video 1 & 2.

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