Hepatomegaly and Focal Liver Lesions Flashcards
solid liver lesions in older people?
more likely to be malignant
likely to be metasteses
solid liver lesions in chronic disease?
.
when are liver lesions detected?
cirrhosis screening
imaging for abdominal pain, deranged LFTs, resp problems
benign liver lesions?
haemangioma
focal nodular yperplasia
adenoma
liver cysts
malignant liver lesions?
primary liver lesions
- hepatocellular carcinoma
- choloangiocarcinoma
metastases
what is a haemoangioma?
most common liver tumour more in females hypervascular tumour usually singlesmall well dermarcated capsule usually asymptomatic
how is haemoangioma diagnosed?
US = echogenic spot, well dermarcated
CT = venous enhancement from periphery to centre (bright white)
MRI = high intensity area
no need for FNA
how is haemangioma treated?
no treatment needed
what is a focal nodular hyperplasia (FNA?)
benign nodule formation of normal liver tissue
congenital vascular anomaly; assoc with Osler-Weber-Rendu and liver haemangioma
what are the clinical features of FNH?
classically - central scar containing a large artery, radiating branches to the periphery (Hub and Spoke)
Hyperplastic response to abnormal blood flow
Usually asymptomatic, may cause slight pain
More common in young/middle age women
How is FNH diagnosed?
US = nodule with varying echogenicity CT = hypervascular mass with central scar MRI = Iso or Hypo intense FNA = normal hepatocytes and kupffer cells with central score
how is FNA treated?
no treatment needed
what is a hepatic adenoma?
benign neoplasm composed of normal hepatocytes, no portal tract, central veins or bile duct
More common in women, assoc with contraceptive pill and anabolic steroids
what are the clinical features of hepatic adenoma?
usually asymptomatic, can have RUQ pain
May present with rupture, haemorrhage or malignant transformation (V. rare, more in males)
Symptoms depend on size
describe the most common hepatic adenoma
usually solitary fat containing lesions
usually in right lobe
Multiple adenomas (adenomatosis) is a rare condition assoc with glycogen storage disease
what are hepatic adenomas associated with?
oral contraception
androgenic steroids
regression can occur after discontinuation
how are hepatic adenomas diagnosed?
US = filling defect CT = diffuse arterial enhancement MRI = hypo/hyper intense lesion FNA = may be needed
how are hepatic adenomas treated?
Stop hormones, weight loss Males = surgical excision Females = imaging after 6 months - < 5cm or reducing = annual MRI - > 5cm or growing = surgical excision
what are the clinical features of a simple cyst?
liquid collection lined by epithelium
No biliary tree communication
Solitary and uniloculated
what are the symptoms of a simple cyst?
usually asymptomatic Symptoms related to - intracystic haemorrhage - infection - rupture - compression
how is a simple cyst managed?
no follow up needed
Imaging after 3-6 months if in doubt
Consider surgery if symptomatic or uncertain diagnosis
what are the clinical features of hydatid cyst?
echinococcus granulosus (tapeworm) Travel to East Europe, Central/South America, Middle East and North Africa
what are the symptoms of Hydatid cyst?
disseminated disease
erosion of cysts into adjacent structures and vessels (IVC)
how is Hydatid cyst diagnosed?
history
appearance
serologic testing - detects anti echinococcus antibodies
How are Hydatid cysts managed?
Usually surgery - open cystectomy, marsupialization - Pericystectomy, lobectomy Medical = Albendazole Percutaneous drainage
What is polycystic liver disease (PLD)?
Embryonic ductal plate malformation of the intrahepatic biliary tree
Numerous cysts throughout liver parenchyma
what are the 3 types of polycystic liver disease?
Non Meyenburg complexes (VMC)
Polycystic Liver disease
Autosomal dominant polycystic kidney disease
