Liver (Anatomy, Benign Lesions)

Question 1

CT findings of colorectal mets

Answer 1

Low attenuation compared with surrounding parenchyma during portal phase enhancement

Question 2

CT findings of hepatic adenoma

Answer 2

Uniform filling with bright arterial phase enhancement

Question 3

Which drugs are associated with the growth of hepatic adenomas?

Answer 3

OCPs

Anabolic steroids

Question 4

Function of glucuronyl transferase

Answer 4

Conjugates bilirubin to glucuronic acid

Question 5

Segments VII and VIII are both in the ____ lobe and ____.

Answer 5

Right, superior

Question 6

Segment IV

Answer 6

L medial segment (quadrate lobe)

Question 7

What is Cantlie’s line?

Answer 7

Line drawn from the middle of the gallbladder fossa to the IVC, delineates right and left lobes

Question 8

FNH is a (benign/premalignant) lesion.

Answer 8

Benign

Question 9

Rate of spontaneous hemorrhage of a giant hemangioma:

Answer 9

<1%. Nonspontaneous rupture is also very rare.

Question 10

Segment VIII

Answer 10

Superior R anteromedial segment

Question 11

Most common benign tumor of the liver

Answer 11

Cavernous hemangioma

Question 12

Falciform ligament delineates separation between:

Answer 12

Medial and lateral segments of left lobe

Question 13

Inferior R posterolateral segment #

Answer 13

Segment VI

Question 14

CT findings of HCC

Answer 14

Arterial enhancement with early washout of contrast

Question 15

Superior R anteromedial segment #

Answer 15

Segment VIII

Question 16

Thrombocytopenia, low fibrinogen secondary to fibrinolysis and hemangioma: (name of syndrome)

Answer 16

Kasabach-Merritt syndrome, more common in children

Question 17

A young woman on OCPs presents with acute abdominal pain and is found to have acute hemorrhage within a hepatic adenoma. Treatment (acute, post-acute (total 3)).

Answer 17

Acute: Embolization of the adenoma
Post-acute: Stop OCPs, elective resection

If embolization is impossible and the patient is hemodynamically unstable, “trauma” laparotomy with Pringle maneuver, packing and formal resection vs ethanol injection or RFA as required to control hemorrhage.

Question 18

US findings of hemangioma:

Answer 18

Well-circumscribed, hyperechoic and homogenous

Question 19

Segments V and VIII are both in the ____ lobe and ____.

Answer 19

Right, anteromedial

Question 20

What vitamins are stored in the liver?

Answer 20

Fat-soluble (ADEK), and B12 (only water-soluble vitamin to be stored in the liver)

Question 21

Segment III

Answer 21

Inferior L lateral segment

Question 22

Segment V

Answer 22

Inferior R anteromedial segment

Question 23

What delineates the right and left lobes?

Answer 23

Cantlie’s line (also known as portal fissure): line drawn from the middle of the gallbladder fossa to the IVC

Question 24

CT findings of hemangioma (arterial, portal and delayed phases)

Answer 24

Peripheral enhancement in arterial phase
Centripetal filling in portal venous phase
Retention of contrast on washout/delayed phase

Question 25

Cavernous hemangiomas are more common in (women/men) with a ____ ratio.

Answer 25

Women, 3:1

Question 26

Inferior R anteromedial segment #

Answer 26

Segment V

Question 27

A well-circumscribed, hyperechoic and homogenous hepatic lesion on US is a:

Answer 27

hemangioma

Question 28

After aspiration and injection of a sclerosing agent into a hepatic cyst, what is the rate of symptomatic recurrence?

Answer 28

5-10%. In these patients, surgical intervention is more difficult and associated with increased morbidity.

Question 29

Segments V and VI are both in the ____ lobe and ____.

Answer 29

Right, inferior

Question 30

Segment I

Answer 30

Caudate lobe

Question 31

Segment II

Answer 31

Superior L lateral segment

Question 32

A giant hemangioma is at least ____.

Answer 32

5cm

Question 33

What raises the likelihood of malignancy in a hepatic cyst? (4)

Answer 33

High-density fluid Nodules Septations Irregular, thickened wall

Question 34

CT findings of FNH

Answer 34

Characteristic hypoattenuated central scar, which may enhance on delayed images. Enhances brightly on arterial phase and becomes isodense on portal phase

Question 35

Inferior L lateral segment #

Answer 35

Segment III

Question 36

While trying to differentiate between FNH and adenoma during the analysis of a liver lesion, intralesional fat is identified. The lesion is a:

Answer 36

Steatotic adenoma

Question 37

Segment VI

Answer 37

Inferior R posterolateral segment

Question 38

Caudate lobe (segment #)

Answer 38

Segment I

Question 39

L medial segment #

Answer 39

Segment IV

Question 40

Segments VI and VII are both in the ____ lobe and ____.

Answer 40

Right, posterolateral

Question 41

Indications for resection of hepatic adenoma (4)

Answer 41

Size >5cm (increased risk of malignancy) Male gender (increased risk of malignancy) Inability to rule out malignancy Symptoms

Question 42

Superior posterolateral segment #

Answer 42

Segment VII

Question 43

While trying to differentiate between FNH and adenoma during the analysis of a liver lesion, the lesion is demonstrated to take up Eovist on MRI. The lesion is a:

Answer 43

FNH (as these are normal hepatocytes, they take up hepatic-specific contrast agents such as Eovist.)

Question 44

Risk factors for hepatic adenoma harboring undiagnosed HCC: (2)

Answer 44

Size >5cm | Male gender

Question 45

Superior L lateral segment #

Answer 45

Segment II

Question 46

Cause of physiologic jaundice of the newborn:

Answer 46

Immature glucuronyl transferase leading to high levels of unconjugated bilirubin

Question 47

Segment VII

Answer 47

Superior R posterolateral segment