LIVER

Question 1

Diagnosis of FNH can be established radiographically with

Answer 1

On unenhanced CT, lesions are typically isoattenuated with a normal liver and may have the characteristic hypoattenuated central scar.

With contrast in the arterial phase, FNHs enhance brightly and become isoattenuated to adjacent parenchyma in the portal phase.

Small feeding vessels may be seen on the periphery of these lesions in the arterial phase. The central scar may enhance on delayed phases.

Question 2

A well-defined mass with contrast enhancement during arterial phase and rapid washout during portal phase is consistent with

Answer 2

hepatic hemangioma.

careful rapid washout on portal phase is not the same as central scar

Question 3

A well-defined mass with internal septae, papillary projections, intratumoral hemorrhage and fine calcifications is consistent with

Answer 3

benign hepatic cyst.

Question 4

A poorly defined mass located peripherally with low attenuation, area of central necrosis, and cystic degeneration is consistent with

Answer 4

metastatic hepatic lesion.

Question 5

The treatment of hepatic 5 cm heterogenous cyst in the right lobe of the liver that is calcified

Answer 5

hydatid cysts

A number of operations have been used, but in general, the abdomen is completely explored, the liver mobilized, and the cyst exposed.

Packing off of the abdomen is important because rupture can result in anaphylaxis and diffuse seeding.

Usually, the cyst is then aspirated through a closed- suction system and flushed with a scolicidal agent such as hypertonic saline.

The cyst is then unroofed, which can then be followed by a number of possibilities, including excision (or pericystectomy), marsupialization procedures, leaving the cyst open, drainage of the cyst, omentoplasty, or partial hepatectomy to encompass the cyst.

Chemotherapy for echinococcosis with albendazole or mebendazole is effective at shrinking cysts in many patients granulosus but cyst disappearance occurs in fewer than 50% of patients.

Preoperative treatment may decrease the risk for spillage and is a reasonable and safe practice.

Chemotherapy without definitive resection or drainage is only considered for widely disseminated disease or patients with poor surgical risk.