Carol Diagnostic Ultrasound

Question 1

What is the papillary process in liver?

Answer 1

The papillary process is the anteromedial extension of the caudate lobe, which may appear separate from the liver and mimic lymphadenopathy.

Question 2

Please described the common vascular variation in liver?

What is the most common?

Answer 2

55% have normal vascular anatomy
About 45% have some variation of anatomy,  which are 
(1) replaced left hepatic a.
     originating from the left gastric artery (10%)
(2) replaced right hepatic a.
     originating from the SMA (11%)
(3) replaced common hepatic artery 
     originating from the SMA (2.5%).

Question 3

Please described Five major sites of portosystemic venous collaterals in cirrhosis..

Answer 3

1. Gastroesophageal junction:
   » Coronary and short gastric v.
   to the systemic esophageal veins.
2. Paraumbilical vein:
   &raquo_space; Left portal vein →Paraumbilical vein
   (Runs in the falciform ligament) → systemic
   epigastric veins near the umbilicus
   (Cruveilhier Baumgarten syndrome)
3. Splenorenal and gastrorenal:
   &raquo_space; Tortuous veins in region of splenic and left renal hilus, which represent collaterals between the splenic, coronary, and short
   gastric veins and the left adrenal or renal veins.
4. Intestinal:
   » Regions in which GI tract becomes retroperitoneal so that the veins of ascending and descending colon, duodenum, pancreas, and liver may anastomose with the renal, phrenic, and lumbar veins (systemic tributaries).
5. Hemorrhoidal:
   » Perianal region where the superior rectal veins, which extend from IMV anastomose with the systemic middle and inferior rectal veins.

Question 4

About Hemangiosarcoma (Angiosarcoma)…

Does it common malignant tumor in liver?
Which age groups does it occur?
What specific carcinogens do associate?
What is it sonographic appearance?

Answer 4

Hemangiosarcoma (Angiosarcoma)
> an extremely rare malignant tumor.
> almost exclusively in adults,
peak incidence in sixth and seventh decades.
> Association with specific carcinogens:
Thorotrast, arsenic, and polyvinyl chloride.
> Sonographic appearance is..
large mass of mixed echogenicity