Liver Abnormalities Flashcards
1
Q
_____ of the liver is incompatible with life (not having one).
A
Agenesis
2
Q
Often, with agenesis of the RLL, the _____ lobe is also absent.
A
caudate
3
Q
T or F? With agenesis, compensatory hypertrophy of the remaining lobes normally occurs and the LFTs are normal.
A
True
4
Q
This position abnormality is when the liver is found in the left hypochondrium.
A
situs inversus totalis
5
Q
In congenital diaphragmatic hernias or omphalocele, varying amounts of liver may herniate into the _____ or outside the _____ cavity.
A
thorax
abdominal
6
Q
If someone has kidney cysts, they probably have _____ cysts too.
A
liver
7
Q
T or F? Kidney cysts are more common than liver cysts.
A
True
8
Q
Liver cysts occurrence increases past the age of _____.
A
80
9
Q
Benign hepatic cysts are _____ (echogenicity) with well-demarcated _____ (thickness) walls and posterior acoustic enhancement.
A
anechoic
thin
10
Q
Is active intervention of cysts recommended in patients without symptoms?
A
No
11
Q
Occasionally, the patient may develop pain and fever secondary to cyst hemorrhage or infection. In this case, the cyst may contain internal _____ and _____, a _____ wall, or may appear _____ .
A
echoes
septations
thickened
solid
12
Q
T or F? Cyst ablation with alcohol can be performed using U/S guidance.
A
True
13
Q
Rather than ablation with alcohol, what is another treatment for cysts?
A
surgical excision
14
Q
A hemorrhagic liver cyst will appear as a cyst with _____ _____, accompanied by (2)
A
internal echoes
acute RUQ pain
decreased hematocrit
15
Q
If you see cysts in the kidneys, always check the _____ for cysts as well.
A
liver
16
Q
The adult form of _____ _____ disease is inherited in an autosomal dominant pattern. The frequency with liver cysts in association with this disease is high.
A
polycystic kidney disease
17
Q
_____ is a term for liver inflammation due to viruses or toxins.
A
Hepatitis
18
Q
Hepatitis is _____ when it lasts for less than 6 months.
A
acute
19
Q
This kind of hepatitis is more likely to be asymptomatic in younger people. The convalescent stage is 7 to 10 days, with the total illness lasting 2 to 6 weeks.
A
acute viral hepatitis
20
Q
If you see a hypoechoic liver parenchyma, hepatomegaly, and hyperechoic PV walls, this is a sign of
A
acute hepatitis
21
Q
This hepatitis shows diffuse swelling of the hepatocytes, proliferation of Kupffer cells, and infiltration of the portal areas by lymphocytes and monocytes.
A
acute hepatitis
22
Q
More specific symptoms of acute hepatitis are (6)
A
profound loss of appetite aversion to smoking (in smokers) dark urine yellowing of the eyes jaundice abdominal discomfort
23
Q
These 2 symptoms of the most common presenting symptoms of acute hepatitis.
A
jaundice
hepatomegaly
24
Q
What are the 6 kinds of hepatits?
A
A B C D E G
25
Hepatitis A is also called
infectious jaundice
26
Hepatitis A is transferred by what route?
fecal-oral
27
Does Hepatitis A have an acute and chronic stage?
No, just acute
28
Hepatitis A occurs most frequently in _____ world countries. There is a vaccine that prevents it for up to _____ years. People with Hep A are advised to _____, _____, _____ . Hep A can spread through consumption of raw sea food or contaminated _____ .
```
third
10
rest
stay hydrated
avoid alcohol
water
```
29
Which hepatitis is the least serious?
A
30
The combination of these two forms of hepatitis can cause a _____, and even without cirrhosis, leading to a life-threatening form of fulminant hepatitis.
Hep A and Hep C
| superinfection
31
Does Hep B have both acute and chronic versions?
yes
32
A vaccine for Hep B exists that prevents infection for how long?
life
33
This form of hepatitis can lead to hepatocellular carcinoma.
Hep B
34
The methods of transmission for Hep B are
blood and body fluids
35
Symptoms of this kind of hepatitis occur long after the initial infection, around 4 to 24 weeks and patients may not even experience them. The pain can resemble arthritis, affecting specific joints and accompanied by redness and swelling.
Hep B
36
5-10% of people with Hep B eventually develop
cirrhosis
37
Hep B poses a risk for _____ cancer.
liver
38
Hep C is also called
Non-A/Non-B
39
This is the most common blood-borne infection.
Hep C
40
People can get this type of hepatitis from inadequately sterilized medical or dental equipment.
Hep C
41
Hep C is spread by contact with
infected human blood
42
T or F? Hep C can be passed from an infected mother to her baby during birth.
True
43
Does breastfeeding increase transmission of Hep C?
No
44
Before 1990, Hep C was primarily transmitted by
blood transfusions
45
Most patients with Hep C _____ (do/do not) experience symptoms.
do not
46
If someone experiences symptoms from Hep C, it is often after _____ months of infection.
12
47
Chronic hepatitis C can be present for _____ - _____ years, and _____ or _____ can sometimes develop before patients experience any clear symptom.
10-30 years
cirrhosis
liver failure
48
Nearly 40% of liver transplant patients are infected with Hep _____.
C
49
Is liver transplantation a cure for Hep C?
No
50
This kind of hepatitis is only dangerous if you also have Hep B.
Hep D
51
Hep D is also called
hepatitis delta virus
52
T or F? Hep D was discovered as an antigen in Hep B virus by Dr. Mario Rizzetto in 1977.
True
53
Hep D is an uncommon infection in North America, but the people who are primarily infected are
IV drug users
54
How is Hep D spread?
thought to be similar to Hep B, blood
possibly sexual transmission
55
Is there any specific treatment for Hep D? But what is a possible alternative-type treatment that has been used in the past with some success? And what is another possible treatment?
No
High dose of interferon given for over 12 years
orthotopic liver transplant
56
Persistence of biochemical abnormalities beyond 6 months is
chronic hepatitis
57
What is the sonographic appearance of chronic hepatitis?
hyperechoic parenchyma
small, shrunken liver
decreased echogenecity of PV walls
(opposite of acute hepatitis)
58
Abscesses = ? and ?
leukocytosis
| fever
59
This is a puss-filled area in the liver.
Pyogenic liver abcess
60
What are some of the causes of liver abscesses?
- Abdominal infection such as appendicitis, diverticulitis, or a perforated bowel
- Infection in the blood
- Infection of the liver secretion (biliary) tract
- Recent endoscopy of the biliary system
- Trauma that damages the liver
61
The most common presenting features of pyogenic liver abscess are:
```
Chalk-colored stool
Dark urine
Fever, chills, leukocytosis
Loss of appetite
Nausea, vomiting
Pain in right upper abdomen (more common) or throughout the abdomen (less common)
Unintentional weight loss
Weakness
Yellow skin (jaundice)
```
62
Pyogenic liver abscesses most commonly occur in the ______ lobe.
right lobe
63
How do pyogenic liver abscesses reach the liver (4)?
Bile ducts
PVs
HAs
lymphatic channels
64
Varied appearances of pyogenic liver abscesses are:
***There is “air” within the abscess***
Purulent abscesses appear cystic with the fluid ranging from echofree to highly echogenic
Early suppuration may appear solid with altered echogenicity, usually hypoechoic
The abscess wall can vary from well-defined to irregular and thick
Gas-producing organisms give rise to echogenic foci with a posterior reverberation artifact.
65
For true diagnosis of pyogenic liver abscesses, what must be done?
aspirate the abscess
66
Treatment for pyogenic liver abscesses is
surgery
draining the abscess
along with this procedure, you will receive long-term antibiotic therapy (usually 4 - 6 weeks).
sometimes antibiotics alone can cure the infection
67
With pyogenic liver abscesses, what life-threatening condition could develop?
sepsis
68
Even with treatment, pyogenic liver abscesses can be life-threatening in _____% to _____% of patients.
10% - 30%
69
When you hear "air in the abscess", you should automatically think
pyogenic liver abscess
70
This is a liver infection that occurs when a parasite that came from the intestines reaches the liver, and travels through the portal vein.
amebic abscess
71
This is the most common extraintestinal complication of amoebic dysentery
amebic abscess
72
Transmission of amebic abscess is by the _____-_____ route. The most common bacterial agent related to this is ______.
fecal-oral
| e-coli
73
The most common presenting symptoms of amebic abscess are
right upper quadrant pain
| diarrhea
74
Sonographic signs of amebic abscesses are (7)
Round or oval-shaped lesion
Absence of a prominent abscess wall
Hypoechoic compared to a normal liver
Fine low-level internal echoes
Distal enhancement
Contiguity with the diaphragm/liver capsule
Typically occurs in the dome of the liver (RLL)
75
T or F? For amebic abscesses, amebicidal drugs are effective and symptoms improve by 24-48 hours but complete resolution of the abscess varies from 1.5 – 23 months with a median of 7 months.
True
76
Possible dangerous risks of amebic abscesses are
may rupture into the abdominal cavity, the lining of the lungs, the lungs, or the sac around the heart
could spread to the brain
77
This is a mycotic (fungal) infection of the blood that results in small abscesses in the liver. The appearance of these lesions can change over the course of the disease process.
candidiasis
78
The ultrasonic appearance of Candida infection in the livers of immunosuppressed patients is quite characteristic:
"Wheel Within A Wheel”: a lesion with a peripheral hypoechoic zone, an inner echogenic wheel and a hypoechoic center. This is the earliest manifestation of a fungal infection and the most recognizable.
79
After some time, later the “wheel within a wheel” turns into a “______” appearance when the hypoechoic center ______.
It will then turn into a(n) uniformly ______ (echogenecity) focus and then a(n) ______ (echogenecity) focus representing scar formation.
“bullseye”
calcifies
hypoechoic
echogenic
80
What is the most common cause of hydatid disease?
echinococcal cyst
81
This is a result of a parasite infestation (tapeworm) associated with sheep and cattle raising countries.
echinococcal cyst
82
Eggs of Echinococcus granulosus are swallowed by the intermediate host (man) and pass into the ______ ______ system where the larva hatch and move into the ______.
portal venous system
| liver
83
The tapeworm of the parasite infestation for an echinococcal cyst is ______-______ mm in length and usually lives in the intestines of the definitive host (dog), excreted in the dog’s feces and swallowed by the intermediate hosts (sheep, cattle, goats or humans).
3-6 mm
84
The sonographic signs for an echinococcal cyst are (5)
Simple cyst
Cysts with detached endocysts secondary to rupture (a cyst within a cyst)
Cyst with multiple daughter cysts
Cyst with detached membrane (water lily sign)
Calcified mass
85
An old test used to diagnose hydatid disease was called the ______. It was usually about ______% sensitive.
Casoni skin test
| 70%
86
For treatment of an echinococcal cyst, _____ is the conventional treatment, but success has been obtained with _____ as well.
surgery
| percutaneous drainage
87
The fluid within the echinococcal cyst is very toxic, so if a cyst ruptures _____ can occur.
anaphylatic shock
88
This is one of the most common parasitic worm infections in humans, affecting 200 million people worldwide found in parts of the world where the water is contaminated.
It is a major cause of portal HTN worldwide.
Schistosomiasis
89
Explain how schistosomiasis occurs
Freshwater becomes contaminated by Schistosoma eggs when infected people urinate or defecate in the water. The eggs hatch, and if certain types of snails are present in the water, the parasites grow and develop inside the snails. The parasite leaves the snail and enters the water where it can survive for about 48 hours.
Adult worms are about 10 mm long.
Parasites reach maturity in 6 to 8 weeks, at which time they begin to produce eggs.
Up to half the eggs released by the worm pairs become trapped in the mesenteric veins, or will be washed back into the liver, where they will become lodged. Worm pairs can live in the body for an average of four and a half years, but may persist up to 20 years.
Eggs travel to the liver or pass into the intestine or bladder, causing inflammation or scarring.
90
Eggs from schistosomiasis reach the liver through the _____ inciting a _____ reaction resulting in _____ .
portal vein
granulomatous
peri-portal fibrosis
91
The peri-portal fibrosis caused by schistosomiasis causes _____ which will lead to _____.
thrombosis
| portal HTN
92
What is seen sonographically with schistosomiasis? (5)
intrahepatic PVs occlude
```
resulting in
portal HTN
splenomegaly
varices
ascites
```
93
This is the most common fungal organism causing opportunistic infection in patients with AIDS.
It is the most common cause of life-threatening infection in patients with HIV.
pneumocystis carini
94
This condition also affects patients undergoing bone marrow and organ transplants, as well as those receiving corticosteroids or chemotherapy.
pneumocystis carini
95
The sonographic appearance and medical results of pneumocystis are (10)
```
Fatty liver infiltration
Hepatomegaly
Hepatitis
Non-hodgkins lymphoma
Candidiasis
Cholangitis
Acalculous cholecystitis
Kaposi’s sarcoma
```
May involve the liver with diffuse, nonshadowing hyperechoic foci.
May cause the bile ducts and GB wall to be thickened.
96
This infection and this malignancy can signal the final stages of HIV/AIDS.
pneumocytosis
| Kaposi's sarcoma
97
Another word for pneumocystis carini is
pneumocytosis
98
2 other AIDS related findings are
cholangitis (thickend bile ducts)
| Kaposi's sarcoma (intrahepatic mass)
99
A fatty liver is an acquired, reversible disorder of metabolism, resulting in an accumulation of _____ within the hepatocytes.
triglycerides
100
The most common causes of a fatty liver are ______ and ______.
obesity
| alcohol abuse
101
The 2 patterns of a fatty liver are
focal fatty infiltration (diffuse)
| focal fatty sparing (focal)
102
The echogenicity of the liver compared to the kidney is more ______ than the kidney.
hyperechoic
103
A potential problem in the presence of diffuse fatty infiltration is
misdiagnosis of a hypoechoic solid lesion as a simple cyst
104
How does the misdiagnosis of a hypoechoic solid lesion as a simple cyst occur?
Since the overall gain is turned down to compensate for a bright liver, low level echoes within a solid lesion may be missed. With the TGC turned up to compensate for reduced through transmission, the hypoechoic solid lesion may have posterior enhancement.
105
What visual finding can help distinguish between a solid lesion and simple cyst?
The solid lesion will lack the specular reflection seen in the posterior wall of a cyst, as it does not have a fluid tissue interface.
Fine-needle aspiration may be necessary if the ultrasound findings are equivocal.
106
Focal regions of increased echogenicity within normal liver parenchyma is
focal fatty infiltration
107
Focal regions of normal liver parenchyma within a fatty infiltrated liver.
focal fatty sparing
108
Sparing commonly occurs adjacent to the ______, in the porta hepatis, the ______, and at the liver margins.
GB
| caudate lobe
109
A genetically acquired disorder that results in the excess deposit of glycogen in the liver and tubules of the kidney.
glycogen storage disease
110
This is associated with diffuse fatty infiltration and hepatic adenomas (well-demarcated, solid masses of variable echogenicity).
glycogen storage disease
111
______ is a diffuse process of fibrosis and distortion of normal liver architecture.
cirrhosis
112
Patients with cirrhosis are at an increased risk for ______.
hepatocellular carcinoma
113
With cirrhosis, initially there is ______ enlargement, but continued insult results in ______. Parenchymal changes compress the biliary and ______ channels resulting in ______ and ______.
```
liver
hepatic atrophy
vascular
jaundice
portal HTN
```
114
The 2 most common causes of cirrhosis are
```
ETOH abuse (alcohol abuse)
Hepatitis C
```
115
ETOH was once the main cause of cirrhosis in the U.S. ______ has emerged as the leading cause now
Hep C
116
The 3 major pathologic mechanisms which create cirrhosis are
Cell death
Fibrosis
Tissue Regeneration (bad kind)
117
Cirrhosis is classified as ______ (nodules 0.1 – 1 cm in diameter) or ______ (nodules up to 5 cm in diameter).
Micronodular
| Macronodular
118
______ is the MOST COMMON cause of micronodular cirrhosis.
alcohol consumption
119
______ is the MOST FREQUENT cause of macronodular cirrhosis.
chronic viral hepatitis
120
Clinical presentations of cirrhosis are (3)
Hepatomegaly
Jaundice
Ascites
121
This condition can cause you to be "crazy" because the liver cannot get rid of the toxins and ammonia, which causes encephalopathy.
cirrhosis
122
Cirrhosis - match the volume distribution with the type:
Acute
Chronic
Small liver, large Caudate lobe
Hepatomegaly
Acute - Hepatomegaly
| Chronic - Small liver, large Caudate lobe
123
The 3 sonographic patterns for cirrhosis are:
1) volume redistribution
2) coarse echotexture
3) nodular surface
124
The nodularity with cirrhosis corresponds to the presence of regenerating ______ and ______.
nodules
| fibrosis
125
Late stages of cirrhosis characteristics are (2)
ascites
| shrunken liver
126
This is defined as increased pressure in the portal venous system.
portal HTN
127
Normal portal pressure is ______-______ mm Hg which is slightly ______ than the normal IVC pressure.
5 - 10 mm Hg
| higher
128
Normal portal vein diameter is < ______ mm
13 mm
129
______ flow in the MPV is a sign of portal HTN.
hepatofugal
130
What are the 2 major causes of portal HTN?
cirrhosis
| schistosomiasis
131
Portal HTN is asymptomatic. Patients typically present with sudden painless upper GI ______ due to rupture of esophageal ______.
hemorrhage
| varices
132
What are the 4 types of portal HTN?
A. Extrahepatic pre-sinusoidal = portal vein thrombosis
B. Intrahepatic pre-sinusoidal = schistosomiasis
C. Intrahepatic = cirrhosis (most common) accounting for 90% of the cases in the West
D. Intrahepatic post-sinusoidal = hepatic vein thrombosis
133
What is the most common type of portal HTN?
intrahepatic
134
What are the secondary signs of portal HTN? (3)
splenomegaly ( >13 cm)
ascites
portosystemic venous collaterals
135
What are 5 major sites of portosystemic venous collaterals?
1) Gastroesophageal junction
2) Paraumbilical vein
3) Splenorenal and gastrorenal
4) Intestinal
5) Hemorrhoidal
136
Gastroesophageal junction: between the coronary and ______and the ______ .
short gastric veins
| esophageal veins
137
Paraumbilical vein: runs in the ______ ligament and connects the LPV to the ______ near the umbilicus, recanalizing the ______.
falciform ligament
epigastric veins
ligamentum teres
138
Splenorenal and gastrorenal: tortuous veins may be seen in the region of the ______ and ______.
splenic
| left renal hilum
139
Intestinal: regions in which the gastrointestinal tract becomes ______, so that the veins of the ascending and descending ______, ______, ______, and ______ may anastomose with the renal, phrenic and ______ veins.
```
retroperitoneal
colon
duodenum
pancreas
liver
lumbar
```
140
Hemorrhoidal: ______ region where the superior rectal veins anastomose with the ______ and ______ rectal veins.
perianal
middle
inferior
141
These are created to decompress the portal system to avoid the development or rupture of gastroesophageal varices with portal HTN.
portosystemic shunts
142
The 3 types of traditional portosystemic shunts are
mesocaval
splenorenal (Warren)
portacaval
143
What does TIPS stand for?
Transjugular
Intrahepatic
Portal
Systemic shunting
144
A TIPS shunt is placed between a ______ and a ______. Usually the ______ (right/left).
HV
PV
right
145
______ ______ ______ is utilized to detect early shunt compromise for prompt shunt revision, usually every 3-6 months.
routine doppler evaluation
146
What are the 4 criteria for TIPS malfunction?
1. Shunt velocity < 50 cm/sec
2. Focal velocity increase (usually at the hepatic end)
3. Hepatopedal flow in the LPV or RPV
4. Hepatofugal flow in the MPV
147
Hepatopedal flow in the LPV or RPV is a sign of what (involving shunts)?
TIPS malfunction
148
Hepatofugal flow in the MPV is a sign of what (involving shunts)?
TIPS malfunction
149
Echogenic thrombus within the lumen of the portal vein
PV thrombosis
150
The 6 causes of PV thrombosis are
```
Hepatocellular Carcinoma
Pancreatic Carcinoma
Metastatic Liver Disease
Pancreatitis
Cirrhosis
Hypercoagulation (women on birth control pills)
```
151
With traditional shunts for lowering portal pressure, the mesocaval shunt connects the ______ and the ______.
SMV
| IVC
152
With traditional shunts for lowering portal pressure, the splenorenal (Warren) shunt connects the ______ and the ______.
SV
| RV
153
With traditional shunts for lowering portal pressure, the portacaval shunt connects the ______ and the ______.
PV
| IVC
154
Wormlike vessels at the porta hepatis, which represent periportal collateral circulation, occurring in longstanding PV thrombosis, requiring up to 12 months to occur.
cavernomatous transformation
155
Cancer = ______ (increased/decreased) risk of blood clots.
increased
156
A relatively rare disorder characterized by occlusion of the hepatic veins with or without occlusion of the IVC by either thrombus or tumor. Typically seen in young adult women taking birth control pills.
Budd-Chiari syndrome
157
The main cause of Budd-Chiari syndrome is
Coagulation abnormalities
158
With Budd-Chiari syndrome, the ______ lobe is often spared. And why?
caudate lobe
| because of emissary veins drain directly into the IVC at a lower level than the main HVs
159
These are sonographic signs of ______:
Ascites is an invariable observation.
Liver is typically large and bulbous acutely. Hemorrhagic infarction may produce significant altered regional echogenicity.
Membranous webs may be identified as echogenic or focal obliterations of the lumen.
Budd-Chiari syndrome
160
______ liver transplantation is performed to eliminate irreversible disease.
orthotopic
161
The main indication for liver transplants in adults is
Cirrhosis due to Hep C
162
The main indication for liver transplants in children is
biliary atresia
163
Before orthotopic liver transplant surgery is done, these details should be checked sonographically (4)
Liver size and extent of pathology
PV, HA, IVC patency/size
Presence of venous collaterals
Presence of complicating factors( like AAA or extrahepatic malignancies)
164
A postoperative U/S for orthotopic liver transplant should include (5)
```
Liver parenchyma
Biliary tree (CBD)
HA, PV, HV patency***
IVC patency
Perihepatic fluid collections
```
165
Unfortunately, in about _____ (fraction) of all patients with chronic hepatitis, the disease recurs after transplantation.
half
166
Most common benign tumor of the liver is
cavernous hemangioma
167
The majority of hemangiomas are asymptomatic and discovered incidentally, usually in the _____ lobe of the liver.
right
168
Is it possible to see the flow in the tiny vessels that make up hemangiomas on U/S?
no
169
Hyperechoic, homogeneous
Posterior enhancement
May appear hypoechoic within the background of a fatty infiltrated liver
Color or duplex Doppler does not routinely demonstrate flow
These are sonographic signs of what?
cavernous hemangioma
170
This liver mass may enlarge with pregnancy or administration of estrogens.
cavernous hemangioma
171
This is a benign solid liver mass that is believed to be related to an area of congenital vascular malformation. It is typically an incidentally detected liver mass in an asymptomatic patient.
focal nodular hyperplasia
172
Focal nodular hyperplasia is a mass more common in ______ (men/women).
women
173
Well defined solid mass
Central fibrous scar (liver mass with an echogenic line through it)
Stellate vascularity
It is often difficult to differentiate in echogenicity from the adjacent liver parenchyma
These are sonographic signs of what?
focal nodular hyperplasia
174
This is a solid liver mass associated with the use of oral contraceptive agents.
hepatic adenoma
175
Patient may present with pain due to tumor hemorrhage. Associated with glycogen storage disease.
These are signs of what liver mass?
hepatic adenoma
176
Surgical resection is recommended for hepatic adenomas due to the risk of
malignant transformation
177
Sonographic signs of hepatic adenoma are (3)
Nonspecific echogenicity
Cystic component with hemorrhage
Intraperitoneal blood
178
Hepatic Adenoma is often difficult to distinguish from ______ on an U/S.
focal nodular hyperplasia
179
Extremely rare fatty tumors in the liver are
hepatic lipoma
180
Tuberous sclerosis, a congenital familial disease, is associated with ______ and ______.
hepatic lipomas
| angiomyolipomas
181
Hyperechoic mass
Propagation speed artifact
These are sonographic signs of
hepatic lipomas
182
This may be seen as a broken diaphragm posterior to the fatty mass on an U/S (and diaphragms don’t break).
hepatic lipomas
183
The MOST COMMON PRIMARY malignancy of the liver is
hepatocellular carcinoma
184
Another term for hepatocellular carcinoma is
hepatoma
185
Etiology factors:
Alcoholic cirrhosis and Hep B and C
Commonly invades PVs, HVs, and IVC
Variable sonographic appearance
Serum alpha-fetoprotein level will be increased
These are signs of what?
hepatoma (hepatocellular carcinoma)
186
One of the biggest signs of ______ is the increase of serum alpha-fetoprotein levels.
hepatocellular carcinoma (hepatoma)
187
______ are the most commonly encountered solid masses in the liver.
metastatic tumors
188
The most common source of metastatic involvement is from ______, ______, or ______ cancer.
gastrointestinal
breast
lung
189
Metastatic tumors:
Hyperechoic mets come from
the gastrointestinal tract
190
Metastatic tumors:
Hypoechoic mets come from
lymphoma
191
Metastatic tumors:
Bulls eye or target mets come from
lung
192
Metastatic tumors:
Calcified mets come from
mucinous adenocarcinoma
193
Metastatic tumors:
Cystic mets come from
sarcoma
194
Metastatic tumors can also present as mass of ______ echogenicity.
mixed
195
The most common malignant liver tumor in early childhood is
hepatoblastoma
196
Hepatoblastoma is the 3rd most common intra-abdominal childhood malignancy after ______ neuroblastoma and ______ tumor.
adrenal
| Wilm's
197
With hepatoblastoma, most occurrences are prior to ______ years of age. Patients present with an enlarging ______ ______ ______ (10-12 cm). Non-specific sonographic appearance.
2
| asymptomatic abdominal mass
198
What is the earliest manifestation of a fungal infection (and most easily seen) in the liver?
Wheel within a wheel
199
Since they are difficult to tell apart, how can you possibly distinguish between a pyogenic abscess and an amebic abscess?
If the patient has traveled outside the US it might be amebic abscess
200
Central fibrous scar =
Focal nodular hyperplasia
201
Echinococcal = ? = ?
Echinococcal =. sheep = water lily sign
