Focal Lesions in the Liver Flashcards
solid liver lesions
older patients = malignant with metastases
chronic liver disease = primary liver cancer
non cirrhotic patients = haemangioma
benign
haemangioma
focal nodular hyperplasia
adenoma
liver cysts
malignant
primary liver cancers - hepatocellular carcinoma, cholangiocarcinoma
metastases
haemangioma
female>males
commonest liver tumour
hypervascualr
usually asymptmatic
haemangioma - diagnosis
US - echogenic spot
CT - venous enhancement from periphery to centre
MRI - high intensity area
no need for FNA
haemangioma - treatment
no need for treatment
focal nodular hyperplasia (FNH)
benign nodule formation of normal liver tissue
congenital vascular anomaly - associated with Osler-weber-rendu and liver haemangioma
central scar containing a large artery, radiating branches to the periphery
hyperplastic response to abnormal arterial flow
sinusoids, bile ductules and kupffer cells present on histology
minimal pain
focal nodular hyperplasia (FNH) - diagnosis
US - nodule with varying echogenicity
CT - hyper vascular mass with central scar
MRI - iso or hypo intense
FNA - normal hepatocytes and kupffer cells with central core
focal nodular hyperplasia (FNH) - treatment
no treatment necessary
hepatic adenoma
benign neoplasm composed of normal hepatocytes no portal tract, central veins or bile ducts
female>male
associated with contraceptive hormones
RUQ pain
rupture, haemorrhage or malignant transformation
transformation risk higher in males
hepatic adenoma - diagnosis
US - filling defect
CT - diffuse arterial enhancement
MRI - hypo or hyper intense lesion
FNA - may be needed
hepatic adenoma - treatment
stop hormones, weight loss
surgical excision
imaging after 6 months
simple cyst
liquid collection lined by an epithelium
no biliary tree communication
solitary and uniloculated
asymptomatic
intracystic haemorrhage, infection, rupture, compression
simple cyst - management
no follow up necessary
doubt = image in 3-6months
surgical intervention
hydatid cyst
echinoccocus granulosus
endemic regions - Eastern Europe, central america, South America, Middle East and North Africa
disseminated disease or erosion of cyst into adjacent structures and vessels
hydatid cyst - diagnosis
detection of anti-echinoccus antibodies
hydatid cyst - mangement
surgery
conservative
radical
risks
medical = albendazole
percutaneous drainage
polycystic liver disease
embryonic ductal plate malformation of the intrahepatic biliary tree
numerous cysts throughout liver parenchyma
Von meyenburg complexes (VMC)
polycystic liver disease
autosomal dominant polycystic kidney disease
Von meyenburg complexes (VMC)
benign cystic nodules throughout the liver
cystic bile duct malformations, originating form the peripheral biliary tree
remanants develop into small hepatic cysts and usually remain silent during life
not gremlin genetically driven
incidental finding
polycystic liver disease
liver function preserved renal failure rare
symptoms = size dependent
PPKCSH and SEC63
autosomal dominant polycystic kidney disease
renal failure due to polycystic kidneys and non-renal extra-hepatic features are common in ADPKD
potential massive hepatic enlargement
PKD1 and PKD2
liver abscess
high fever
leukocytosis
abdominal pain
complex liver lesion
history
abdominal or biliary infection
dental procedure
liver abscess - management
initial empiric broad spectrum antibiotics
aspiration/drainage percutaneously
echocardiogram
operation if no clinical improvement
4 weeks antibiotic therapy with repeat imaging
hepatocellular carcinoma (HCC)
most common primary liver cancer
men>female
risk factor = cirrhosis
