Color Doppler twinkling artifact in a calcified liver mass

Twinkling artifact in color Doppler imaging is related both to the presence of a strongly reflective structure and to the scanner's settings. This artifact has been described in association with calculi and various foreign bodies, but to our knowledge it has not been reported in a hepatic mass. If a calcified hepatic mass is examined with color Doppler Mapping without using spectral Doppler analysis, misinterpreted as real blood flow and lead to the erroneous of hypervascular mass.