This was a 55 year old gentleman, with complaints of dyspepsia , belching and vague abdominal pain of 4 months duration. There was no history of any fever. He was a non smoker and gave history of occasional alcohol consumption. He was working in the middle east and had come to India for evaluation and treatment.

He was seen by a surgeon, who asked for an ultrasound . This was reported as abscess in the right lobe of the liver. He was referred to a medical gastro-enterologist , who asked for a CT scan and it was reported as hypo dense lesion in segment 8  of the liver – probable abscess. As it had a volume less than 40 cc , medical management with antibiotics was given and he was not getting better. He came to our out patient department and he was subjected to a repeat ultrasound.

The following pictures were obtained.

An echogenic nodule with vascularity is seen.

3 d reconstruction shows the solid nature and vascularity around and within the nodule.

The scan was otherwise normal.

The appearance of this nodule was suggestive of a metastatic nodule with the increased vascularity around and within.

An upper G.I.Endoscopy was performed the next day and revealed a primary gastric antral carcinoma.

This case is presented here to underline the point that colour and power doppler can help us in deciding correctly about a gray scale finding which could signify multiple diagnoses.