Hepatic metastases are tumors that have spread to the liver from a primary cancer elsewhere in the body, and they are far more common than primary liver cancers. On ultrasound, metastases can present with highly variable appearances depending on their primary site of origin. They may appear as hyperechoic lesions, often with a hypoechoic rim called a target or bull’s-eye sign; as hypoechoic masses; as calcified lesions with acoustic shadowing; or as cystic or necrotic masses. The presence of multiple lesions of varying sizes in a patient with known cancer is highly suggestive of metastatic disease. Ultrasound is commonly used for surveillance in cancer patients and to guide biopsy of suspicious liver lesions.
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