Why is cavernous hemangioma echogenic?

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Cavernous hepatic hemangiomas look bright on ultrasound because they are built from many blood-filled vascular spaces. The numerous interfaces between these blood-filled caverns reflect ultrasound waves, giving a bright, uniform echogenic appearance compared with the surrounding liver. The slow flow inside the spaces also helps maintain this smooth, highly echoic texture. Other features would point to different processes—calcifications would show bright spots with shadowing, fatty tissue would alter the texture in a different way, and lesions from bile ducts have distinct origins and imaging patterns.