What is a Hypoechoic Mass?

H. Colledge

A hypoechoic mass is a lump which appears relatively darker on an ultrasound scan, because it reflects fewer ultrasound waves. The significance of this finding varies depending on the context. Some tissues normally reflect more or less ultrasound waves than others. When part of an organ changes to reflect more or less ultrasound waves than usual, with the result that it appears brighter or darker than the surrounding tissue, this could indicate an area of disease. Sometimes an entire organ could appear more or less bright than it would normally in comparison with other organs, and this could also be a sign of illness.

Hypoechoic masses show as dark areas on ultrasound scans.
Hypoechoic masses show as dark areas on ultrasound scans.

Ultrasound works by sending out high frequency sound waves which bounce off tissues. A probe sends out the sound signals, and the reflected echoes are captured and transformed into a black and white image displayed on a screen. What are called hyperechoic areas tend to return more waves, while hypoechoic regions return relatively fewer waves. Where sound waves pass through water, there are usually no reflected waves and the area appears black, or anechoic.

A hypoechoic ovarian mass could be a tumor.
A hypoechoic ovarian mass could be a tumor.

A hypoechoic breast mass may be benign, as in the case of a non-cancerous tumor called a fibroadenoma. This appears on an ultrasound scan as a hypoechoic mass with smooth edges. Fibroadenomas are common in young women and may sometimes disappear by themselves, so they are usually only removed if they are large or increasing in size. A breast lump could also be a simple cyst which, being fluid-filled, has an anechoic, rather than a hypoechoic, center surrounded by a well-defined wall. Again, this is a benign, or non-cancerous, mass and can be treated by draining the contents using a needle.

A breast fibroadenoma is a hypoechoic mass that's benign.
A breast fibroadenoma is a hypoechoic mass that's benign.

An ovarian mass which appears hypoechoic on ultrasound could be a tumor known as a fibroma. This is a benign, solid growth which can grow quite large, sometimes becoming bigger than a grapefruit. An ovarian fibroma is usually removed surgically and the ovary may be preserved if possible.

The thyroid gland may be the location of a hypoechoic mass called a follicular adenoma.
The thyroid gland may be the location of a hypoechoic mass called a follicular adenoma.

One example of a hypoechoic mass, seen in the thyroid gland, is a benign tumor called a follicular adenoma. Confusingly, follicular adenomas may also appear hyperechoic, where more sound waves are reflected back, giving a brighter appearance. In either case, follicular adenomas seen on ultrasound scans tend to be surrounded by a ring which is hypoechoic. They are the most common kind of thyroid tumor, and they are often removed as a precaution because it can sometimes be difficult to distinguish them from thyroid cancer.

In the liver, a hypoechoic mass may represent a growth of cancer cells which have traveled from an original tumor elsewhere in the body. This kind of malignant mass, which originates elsewhere, is known as a metastasis, plural metastases. In most cases where cancer has spread to the liver, the disease is not curable, but treatments such as chemotherapy may shrink tumors and increase life expectancy.

A hypoechocoic mass in the liver may represent a growth of cancer cells.
A hypoechocoic mass in the liver may represent a growth of cancer cells.

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Discussion Comments


I have a history of breast cancer. My post mastectomy ultra sound indicates a hypoechoic nodule. Should I be concerned that the cancer has returned?


My mother has undergone chemotherapy and radiotherapy for breast cancer. The follow up checkup ultrasound suggested a very small hypoechoeic lesion in the left lobe of her liver. I am confused as to what it could be. Please help.


W 0.6cm hyperechoic focus was noted in the lower pole of the left kidney. What does this mean?


I've been diagnosed with a 4.9 x 5.0 x 3.8cm complex hypechoic heterogeneous cystic area on the left ovary. It has no internal blood flow and a fishnet appearance. The Radiologist states it's a hemorrhagic cyst.

I'm confused as I can't seem to find any research, matching his descriptions, indicating this is a hemorrhgic cyst. I'm wondering if I should get a second opinion as he has suggested I do not do a repeat ultrasound. Any thoughts?


@ post 1. It cannot be hypoechoic with blood flow in the breast. If it has blood flow, it would more likely be hyperechoic. It should not be touched with a needle if it has blood flow. You need, depending on your age, mammograms yearly and genetic testing if indicated. A repeat ultrasound in three months is ideal in your case.

@post 2: Poster 1 did not say it hurt. If it is associated with pain, its most likely cancer.

@post 3: I don't think a urologist would be happy to see patients with breast lumps. A breast surgeon, like me, would be.

@post 7: These are standard complications which would/could happen to any parotid lump excision, including, but not limited to: bleeding, infection, scar, loss of sensation around incision site, facial nerve injury (the seventh cranial nerve), taste changes, etc.


@anon230060: That's odd. It may be that your husband's body absorbed the nodule or something, but I'd get another opinion from an endocrinologist. I had a nodule on my thyroid last year, and had the right lobe removed early in 2011. It was, thankfully, benign, as are most nodules, but it wasn't doing me any favors being there.

The surgery was done on an outpatient basis and I had no complications.


My husband went to the doctor with dizziness. A workup to include lans, ekg, and carotid doppler were done. The carotid doppler showed a solid nodule on his thyroid. Because of suspicion of thyroid cancer, he was sent for an ultrasound of the thyroid. This was positive for the solid nodule plus several fluid cysts. He was referred to our ENT and he recommended taking the thyroid out because of the solid nodule.

We opted for a second opinion and this doc refused to take it out without more tests. So more labs, and an I123 scan were done. Surprise. On the I123 scan the thyroid was negative for any nodules. Is this possible? He is scheduled for a fine needle aspiration biopsy next week but this will be canceled if the ultrasound can't pick up the nodule. Does a solid nodule just disappear?


I have had results back from the pathologist and it seems this lump in my parotid anteriorly is not malignant. However, I will have to have it surgically removed as it is a growth of some kind and is getting larger. I was also told that there are some risks involved in this procedure which could cause paralysis on the face which could be permanent and that there would also be a scar on my face next to my left ear from the surgery.

Can anyone please tell me if this is normal and if I should consult with another surgeon for a second opinion and also what are your comments, as I have already posted on this site and to date have had no response. Your comments will be most informative to what I decide in the very near future.


I have a hypoechoic mass in the left carotid anteriorly. Is this bad? or am I worrying for nothing? Slides were taken for examination and sent to a pathologist. The lump is not painful.


hypoechoic liver mass? found it on liver ultrasound. no blood flow to such. what does this mean?


@wecallherana - Definitely seek out another doctor. While these things can turn out to be harmless in many cases, that doesn't mean that it's not painful right now.


@wecallherana - Hypoechoic, as stated previously in the article above, is a term used to describe a part of an ultrasound image where the echoes (ultrasonic waves) are not as bright as normal or are less bright than the surrounding structures. I would see a second urologist (or even another urologist in this same group if there is one) for another opinion. I would want them both telling me to wait for a three month follow up before I would feel comfortable with that advice. I think the fact that they just sent you home – even without a prescription for the pain – is absurd personally.


@wecallherana - This can be a very scary thing to go through! My first recommendation is that you get a second opinion and tell them everything you just wrote here. Secondly, you should monitor your pain on a level of 1 through 10 in order to give the Dr a good idea of what's going on in your daily life and how this affects you.

Lastly, this is no laughing matter and they should have a biopsy done. In many cases, the lesion turns out to be harmless, but painful. If this is the case, then you can most certainly have it removed. My research on Breast Cancer (it runs in my family as well) is that the bad lumps don't ever really hurt. Bummer situation, but definitely seek out another Dr.


A few months ago I found a small lump on my right breast through a self examination. At first I assumed it was nothing that was important to worry about. So I kept an eye on it to make sure that I was okay.

My family has a history of breast cancer so I made an appointment. The mass turned out to be "palpable" (a small type of tumor) and the doctor ordered an ultrasound. I was told there is a hypoechoic lesion with blood flow. The Dr. said she wanted to do another ultrasound in three months to see if the mass is growing and told me to take IB Proufen. After the phone call I started thinking and I know it is growing because it was smaller three months ago which is why I made the appointment in the first place.

Does anyone have any advice with anything like this situation? I'm not quite sure what I should do. I'm only trying to be pro-active.

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