Liver

Question 1

What are causes of cystic lesions?

Answer 1

Cyst
Abscess
Hematoma
Cystic met
Biloma
Echinococcus

Rare:
Aneurysm
Arterioportal fistula
Portal-hepatic vein fistula
Hemorrhagic adenoma
Biliary cystadenoma (carcinoma)

Question 2

What are typical appearances of a hemangioma?

Answer 2

Homogenous
Hyperechoic
Usually

Question 3

What is the ddx for hyperechoic masses?

Answer 3

Liver mets
Focal fatty infiltration
Hemangioma

Question 4

What are contrast enhanced ultrasound findings of hemangioma?

Answer 4

Peripheral puddling of contrast

Question 5

What are classic US findings for focal nodular hyperplasia?

Answer 5

Isoechoic or near to liver parenchyma
Central Stellate scar better seen on MR or CT
On Doppler can see a spoke-wheel pattern of internal vascularity.

Question 6

Why do hepatic adenoma a need to be removed? And what is a risk factor for developing?

Answer 6

Risk of bleeding

Oral contraceptive use

Question 7

What is the most common appearance of metastasis?

Answer 7

Target appearance - echogenic or isoechoic centre with a hypoechoic halo.

Question 8

What is the ddx for liver target lesions?

Answer 8

Common:
Mets
HCC

Uncommon:
Lymphoma
FNH
Fungal microabscess
Adenoma

Question 9

Ddx for large calcifications? (4)

Answer 9

Metastasis
Fibeolamellar hepatocellular carcinoma
Old hematoma
Old abscess

Question 10

Ddx for small liver calcifications? (4)

Answer 10

Granulomas
Pneumocystis
Biliary stones
Hepatic arteries

Question 11

Causes of diffuse hepatic inhomogeneity? (3 common, 3 uncommon)

Answer 11

Common:

Cirrhosis
Metastasis
Fatty infiltration

Uncommon:

HCC
Hepatic fibrosis
Lymphoma

Question 12

What is the starry sky sign?

Answer 12

Increased echogenicity of portal triads due to hepatitis

Uncommon findings as there is usually no sonographic evidence of hepatitis. Can also be seen without hepatitis.

Question 13

What are causes of fatty infiltration of the liver?

Answer 13

Obesity
Alcohol
Cholesterol lowering drugs
Chemotherapy
Corticosteroids
Diabetes
Malnutrition
TPN
Toxins - carbon tetrachloride

Question 14

What are findings of fatty infiltration?

Answer 14

Diffuse uniform increase in echogenicity

Question 15

What are typical areas of spared liver parenchyma in fatty infiltration?

Answer 15

Front of right portal vein
Portal bifurcation
Around the gall bladder

Question 16

What are typical locations of focal fatty infiltration?

Answer 16

Adjacent to falciform ligament

Anterior to portal vein bifurcation

Question 17

What is a typical waveform of the portal vein described?

Answer 17

Minimal pulsatility
Flow 20-30cm/sec
Antegrade/hepatopetal

Question 18

How is the normal hepatic vein waveform described?

Answer 18

Retrograde during atrial contraction
Then phase of rapid right atrial filling
Slows then again speeds up when the tricuspid valve opens

Question 19

What are US findings of portal hypertension?

Answer 19

Ascites
Splenomegaly
Portal vein enlargement
Portosystemic collaterals
Enlarged hepatic arteries
Hepatofugal/reversed portal flow

Question 20

What is the classification of portal hypertension?

Answer 20

Intrahepatic:
Post sinusoidal
Presinusoidal

Extrahepatic:
Pre hepatic
Posthepatic

Hyperdynamic

Question 21

What are causes of intrahepatic portal hypertension? Post/pre sinusoidal

Answer 21

Post sinusoidal:

Cirrhosis
Veno-occlusive disease

Pre sinusoidal:

Hepatic fibrosis
Schistosomiasis
Lymphoma
Sarcoidosis

Question 22

What are extra hepatic causes of portal hypertension? Pre and post hepatic

Answer 22

Pre hepatic:

Portal vein thrombosis
Portal vein compression

Posthepatic:

Hepatic vein thrombosis
IVC obstruction
Constrictive pericarditis

Question 23

What are hyper dynamic causes of portal hypertension?

Answer 23

Arterioportal fistula:

Post-Traumatic
Congenital
Atherosclerotic

Question 24

What are US characteristics of cysts?

Answer 24

Anechoic lumen
Increased through transmission
Well defined back wall