Liver

Question 1

Segment 1 liver

Answer 1

Caudate lobe

Question 2

Segment 2 liver

Answer 2

lateral superior left lobe

Question 3

Segment 3 liver

Answer 3

lateral inferior left lobe

Question 4

Segment 4 liver

Answer 4

4a and 4b medial segment left lobe

Question 5

Segment 5 liver

Answer 5

anterior segment inf right lobe

Question 6

Segment 6

Answer 6

posterior segment inf right lobe

Question 7

Segment 7

Answer 7

posterior segment sup right lobe

Question 8

Segment 8

Answer 8

anterior segment sup right lobe

Question 9

Liver cyst

Answer 9

Fluid filled space with epithelial lining. Thin, will defined wall and posterior acoustic enhancement.

Question 10

Peribiliary cysts

Answer 10

• In patients with severe liver disease
• 0.2- 2.5 cm
• small obstructed periductal glands
• Discrete, clustered cysts or tubular appearing structures with thin septae

Question 11

Bile duct hamartomas (VMCs)

Answer 11

• Small focal developmental lesions of liver
  U/s appearance; simple or multiple innumerable well- defined solid nodules less than 1cm. Hypoechoic but can appear hyperechoic. Bright echogenic foci with comet tail artifact.

Question 12

Hepatitis A-E transmission

Answer 12

A: faecal oral
B: parentally (blood transfusions, needle punctures), sexual contact and birth
C: needles or drug injectors
D: uncommon, drug use
E: fecal- oral route

Question 13

Pyogenic bacteria (pyogenic abscess)

Answer 13

• Reaches liver by direct extension from the biliary tract in pts with cholangitis and cholecystitis
  Symptoms: fever, malaise, anorexia, RUQ pain, jaundice
  US appearance: hypoechoic, echogenic foci with posterior reverberation artefact

Question 14

Candidiasis (fungal)

Answer 14

US appearance: wheel in wheel, bulls eye, uniform hypoechoic pattern.

Question 15

Amebiasis (parasite)

Answer 15

• Entamoeba histolytica
• Fecal oral route.
  Symptoms: pain, diarrhea.
  US appearance: round or oval shaped lesion, absence of prominent abscess wall, hypoechogenic liver, fine low level internal echos

Question 16

Hydatid disease

Answer 16

• Enhinococcus granulosus
• sheep and cat
• tapeworm, eggs in dog poo and swallowed by host
• Embryo free in duodenum pass thru mucosa and reach liver through portal vein system.
• Surviving embryos will form slow growing cysts

US appearance; simple cyst, cysts with detached endocyst, daughter cyst, densely calcified masses

Question 17

Schistosomiasis

Answer 17

• Parasite infection caused by schistosoma mansoni, japonicum, mekongi, intercalatum
• Terminal portal vein branches become occluded, presinusoidal portal hypertension, splenomegaly, varices and ascites
  US appearance: widened echogenic portal tracts, enlarged liver

Question 18

Fatty liver (metabolic syndrome)

Answer 18

Causes: obesity, excessive alcohol, pregnancy
US appearance: bright, echogenic, poor sound penetration

Mild: minimal diffuse increase in echogenicity
Moderate: moderate diffuse increase in echogenicity, slightly impaired visualisation of vessels
Severe: marked increase in echogenicity, poor penetration

Question 19

Cirrhosis

Answer 19

Diffuse process characterised by fibrosis
Process: cell death, fibrosis and regeneration
Causes: alcohol and cirrhosis
Appearance: hyper or hypoechoic nodules, volume redistribution, coarse echotexture, nodular surface, regenerating nodules, dysplastic nodules, portal hypertension

Question 20

Portal hypertension

Answer 20

Defined as:

1. Wedge hepatic vein pressure or direct portal vein pressure more than 5mm Hg greater than IVC pressure
2. Splenic vein pressure greater than 15mmHg
3. Portal vein pressure greater than 30cm H20

Question 21

Presinusoidal portal hypertension (extrahepatic)

Answer 21

Extrahepatic causes: thrombosis of the portal or splenic veins. Causes; trauma, sepsis, HCC, pancreatic carcinoma, pancreatitis, portacaval shunts, splenectomy, and hypercoagulable states.

Question 22

Presinusoidal portal hypertension (intrahepatic)

Answer 22

Causes: schistosomiasis, primary biliary cirrhosis, congenital hepatic fibrosis, and toxic substances, such as polyvinyl chloride and methotrexate.

Question 23

Portal vein thrombosis

Answer 23

Causes include; HCC, metastatic liver disease, pancreatic carcinoma, hepatitis
US appearance: echogenic thrombus within the lumen of the vein, portal vein collaterals, expansion of the caliber of the vein, cavernous transformation (wormlike vessels).

Question 24

Budd Chiari

Answer 24

Partial or complete obstruction of the hepatic veins
Clinical presentation: ascites, heptomegaly, abdo pain
Cause: thrombosis in hepatic veins
US appearance: heptomegaly, splenomegaly, heterogenous echotexture, hypertrophied caudate lobe, regenerative nodules, GB wall thickening, ascites

Question 25

Portal vein aneurysm

Answer 25

Rare, proximally at the junction of superior mesenteric and splenic veins.
US appearance; vascular mass connected to the portal system w/ turbulent flow.

Question 26

Haemangioma

Answer 26

Benign tumours that are made up of vascular channels
Small, asymptomatic
US appearance: <3cm in diameter, well defined, homogenous and hyperechoic

Question 27

Focal Nodular Hyperplasia

Answer 27

Second most common benign liver mass due to preexisting arterial spider- like malformation.
US appearance: well circumscribed mass with a central scar, <5cm in diameter.

Question 28

Hepatic Adenoma

Answer 28

Benign tumour that can cause complications such as bleeding and malignant transformation.
Presentation: pt palpable mass RUQ.
US appearance: echogenic solid mass

Question 29

Hepatic Lipomas and AML

Answer 29

Presentation: asymptomatic

US appearance: well defined echogenic mass

Question 30

HCC

Answer 30

• More common in men
  Risk factors: cirrhosis, hep B and C
  Clinical presentation: RUQ pain, weight loss, abdominal swelling, elevated alpha feto- protein levels
  3 forms: solid, multiple nodules, diffuse infiltration
  US appearance: hypoechoic, complex or echogenic, small, hyperechoic,

Question 31

Fibrolamellar carcinoma

Answer 31

Found in younger patients.

Solid tumours, 6cm - 2cm, well differentiated, encapsulated by fibrous tissue.

Question 32

Hemangiosarcoma

Answer 32

Rare malignant tumour.
60-70 years.
Large mass mixed echogenicity.

Question 33

Hepatic metastases

Answer 33

GIT tract, breast carcinoma, lung cancer, GUS system cancer, melanoma. Usually asymptomatic.
US appearance: round, well defined, hypoechoic, hypoechoic halo, cystic, calcified, infiltrative, echogenic appearance.

Question 34

Hepatic trauma

Answer 34

US appearance; fresh hemorrhage echogenic, hepatic laceration becomes more hypoechoic over time. Most common injury was perivascular laceration paralleling branches of the right and middle hepatic veins and the ant and post branches of the r. portal vein.