Liver (IMAGES) Flashcards
Portal Vein
(INTRAsegmental)
Hepatopetal and Monophasic with some variation noted with respiration
Normal Hepatopetal flow in the main portal vein
Hepatic veins
Intersegmental and Hepatofugal with Triphasic low resistance flow
Increase in size towards the diaphragm
Normal doppler signal from the right hepatic vein
Normal doppler finding of the low resistance hepatic artery
Common bile duct is seen being measured with the portal vein seen posterior
Mickey Mouse Sign ( TRV PORTA HEPATIS)
Short arrow ; hepatic artery - left side
Long arrow : common bile duct - right side
Posteriorly seen in the portal vein
This image shows the following ;
Right atrium and IVC (posterior margin) where the right hepatic vein branch is seen
The caudate lobe is seen with the ligamentum venosum
(Short arrow black ) : hepatic artery
Seen posteriorly is the portal vein
Falciform Ligament
Main lobar fissure can be seen between the left medial / lateral segments
Sagittal oblique image of the liver demonstrating the right lobe
With additional view of the gallbladder, right kidney and main lobar tissue seen between the right portal vein and gallbladder
Sagittal image of a diffusely fatty liver that demonstrates the inability to clearly visualize the diaphragm or vasculature
Sagittal image of the liver demonstrating an area of focal fatty infiltration (arrows)
Focal fatty sparing is noted in this sagittal image of the liver adjacent to the gallbladder
Transverse image of the liver demonstrates the “starry sky” appearance frequently associated with hepatitis
Ascites is noted surrounding this liver that is affected by cirrhosis.
Note the irregular, nodular contour of the liver.
Enlargement of the caudate lobe compared to the left lobe is noted in this patient with cirrhosis
A patent or recanalized paraumbilical vein is noted extended from the left lobe of this patient who is suffering from cirrhosis and portal hypertension.
Recanalized paraumbilical vein is demonstrated extended from the left portal vein toward the anterior abdominal wall in a patient with portal hypertension.
patient with portal hypertension, splenic varices are noted adjacent to the spleen in the area of the splenic hilum
Enlarged coronary vein can be seen posterior to the left lobe in a patient with portal hypertension.
Enlarged coronary vein (arrows) can be seen posterior to the left lobe in a patient with portal hypertension.
Enlarged coronary vein (arrows) can be seen posterior to the left lobe in a patient with portal hypertension.
Cavernous transformation of the portal vein. Transverse image through the porta hepatis demonstrates multiple, small collateral vessels in the area of the portal vein.
Benign hepatic cyst. This liver mass has well-defined borders, is completely anechoic, has thin walls, and demonstrates posterior enhancement.
ADPKD cysts
( autosomal dominant polycystic kidney disease)
Hydatid disease. Transverse image of the liver demonstrates a complex mass containing a detached membrane, which is the typical appearance
Water lily sign // mother/ daughter cyst
SONOGRAPHIC FINDINGS OF AN AMEBIC HEPATIC ABSCESS
Round, hypochoic or anechoic mass or masses
May contain debris (with fluid-debris layering)
Acoustic enhancement
SONOGRAPHIC FINDINGS OF A PYOGENIC HEPATIC ABSCESs
1. Complex cyst with thick walls
2. Mass may contain debris, septations, and/or gas
3. The air within the abscess may produce dirty shadowing or ring-down artifact
SONOGRAPHIC FINDINGS OF HEPATIC CANDIDIASIS
1. Multiple masses with hyperechoic central portions and hypochoic borders (may be described as “target,» “halo,” or “bull’s-eye” lesions)
2. typically 1 cm or smaller in size
3. Older lesions may calcify
SONOGRAPHIC FINDINGS OF A CAVERNOUS HEMANGIOMA
1. Small, hyperechoic mass
2. Typically in the right lobe
SONOGRAPHIC FINDINGS OF FOCAL NODULAR HYPERPLASIA
1. Isoechoic, hyperechoic, or hypochoic mass
2. Central scar may appear as hyperechoic or hypochoic linear structure within the mass and will often reveal hypervascularity with color Doppler
SONOGRAPHIC FINDINGS OF A HEPATOCELLULAR ADENOMA
1. Mostly hypochoic
2. May be hyperechoic, isoechoic, or be comprised of mixed echogenicities
SONOGRAPHIC FINDINGS OF HEPATIC HEMATOMA
1. Fresh clot may appear hyperechoic
2. Older hemorrhage can appear anechoic or complex
3. May be intrahepatic or subcapsular
SONOGRAPHIC FINDINGS OF HEPATOCELLULAR CARCINOMA
1. Solitary, hypochoic mass
2. Heterogeneous masses scattered throughout the liver
3. Mass with a hypochoic halo and central echogenic portion (“target” or “bull’s-eye” lesion)
4. Possible ascites
SONOGRAPHIC FINDINGS OF HEPATIC METASTASIS
1. Hyperechoic, hypochoic, calcified, cystic, or heterogeneous masses
2. Mass or masses demonstrating a hypochoic rim and central echogenic region
3. Diffusely heterogeneous liver
4. Possible ascites
SONOGRAPHIC FINDINGS OF HEPATIC METASTASIS
1. Hyperechoic, hypochoic, calcified, cystic, or heterogeneous masses
2. Mass or masses demonstrating a hypochoic rim and central echogenic region
3. Diffusely heterogeneous liver
4. Possible ascites
The wall of the TIPS appears highly echogenic.
transjugular intrahepatic portosystemic shunt.
90 -190 cm/sec
Normal TIPS flow
TIPS failure.
occluded TIPS lacks color-flow filling, and echogenic material (clot) can be noted within the shunt.
Couinaud Segments :
I. Caudatelobemayreceivebranchesofboththerightand left portal veins and may have one or more hepatic veins draining into the inferior vena cava
II. Left lateral superior III. Left lateral inferior
IV. Left medial superior (a) and inferior (b) V. Right anterior inferior
VI. Right posterior inferior VII. Right posterior superior
VIII. Right anterior superior
Ligamentum Venosum
Ligamentum venosum
Normal hepatic vein doppler signal
Fatty infiltration grades
A; grade 1
B; grade 2
C; grade 3
Focal sparing secondary to fatty infiltration.
condition should be suspected in patients who have masslike hypochoic areas in typical locations in a liver that is otherwise increased in echogenicity.
Hepatitis.
The liver texture may appear normal or the portal vein borders are more echogenic than usual (known as the “starry sky” sign), the liver parenchyma is slightly more echogenic than normal, and attenuation may be present.
Chronic hepatitis.
The liver parenchyma is coarse with decreased brightness of the portal triads; however, the degree of attenuation is not as great as is seen in fatty infiltration.
Diffuse liver disease
Fatty infiltration secondary to cystic fibrosis
Diffuse liver disease
Early stages of cirrhosis: hepatomegaly, decreased vasculature.
Cirrhotic liver with ascites.
Advanced cirrhosis with attenuation
Late-stage cirrhosis with shrunken liver and ascites
Late-stage cirrhosis with thick gallbladder wall, ascites, shrunken liver.
Normal hepatic artery doppler findings
The small adenoma presents as a well-demarcated, round, homogeneous, echogenic tumor
With increasing size, the mass may become inhomogeneous
Hemochromatosis.
Hepatomegaly with slightly increased echogenicity throughout the liver parenchyma
Portal hypertension.
Transverse image of hepatosplenomegaly in a patient with advanced cirrhosis, decreased vasculature, and ascites.
Thickened gallbladder wall, accentuated by the ascitic fluid.
Portal hypertension
Hepatomegaly with massive ascites, and the portal vein is filled with thrombus.
The sonographer should search for hepatofugal flow in the portal vein. Note the nodular border of the liver.
The portal vein is dilated and completely filled with thrombus (arrows).
Thrombosis of the main portal vein (arrows) with reduced flow.
Flow reversal within the portal vein
Portal vein thrombosis
TIPS - normal flow
Budd-Chiari syndrome.
Transverse image of the enlarged liver and thrombosis of the inferior vena cava (IVC).
Obstruction proximal to the cystic duct may be secondary to pancreatic carcinoma or tumor invasion to the porta hepatis.
Dilated intrahepatic ducts will result from this obstruction.
Obstruction distal to the cystic duct may be caused by stones in the common duct.
The distal cystic duct is enlarged and obstructed by a stone at the distal end.
The inferior vena cava is posterior to the duct.
Dilated common bile duct
Liver cyst appearing complex due to hemorrhage occurring
Peribiliary cysts
seen as discrete, clustered tubular-appearing cysts with thin septa that parallel the bile ducts and portal veins in the central area of the liver.
Images of a liver parenchyma filled with multiple cystic lesions in patients with hepatic polycystic disease.
Images of a liver parenchyma filled with multiple cystic lesions in patients with hepatic polycystic disease.
Pyogenic abscess is shown as a complex mass in the right lobe of the liver in a patient with cirrhosis, abdominal pain, and fever.
The complex mass has round margins without increased through-transmission.
Amebic abscess is a complex lesion, usually in the right lobe of the liver.
This patient recently returned from a vacation in Mexico and presented with right upper quadrant pain and fever for 2 weeks.
Echinococcal cyst. This complex mass found in the right lobe of the liver shows mixed fluid and debris components.
( hydatid)
Pneumocystis carinii.
The sonographic pattern ranges from diffuse, tiny, nonshadowing echogenic foci to extensive replacement of the liver parenchyma by various echogenic clumps of calcification
Focal nodular hyperplasia
is a subtle liver mass that may be difficult to differentiate in echogenicity from the liver parenchyma.
The mass is usually isoechoic or nearly isoechoic compared with the liver parenchyma.
Hepatic adenoma.
This lesion is usually hyperechoic with a central hypochoic area caused by hemorrhage.
Hepatic adenoma.
This lesion is usually hyperechoic with a central hypochoic area caused by hemorrhage.
Hepatocellular carcinoma: well-defined “bull’s-eye” lesion.
Hepatocellular carcinoma: well-defined isoechoic lesion.
Necrotic hepatoma: necrotic isoechoic lesion.
Advanced metastases: large isoechoic lesions.
Metastases: ill-defined complex necrotic lesion.
Metastases: well-defined hyperechoic lesion.
Hepatocellular carcinoma shows a discrete hypochoic lesion in the right lobe of the liver. C and D, Transverse and sagittal images of the upper right quadrant show a large hepatocellular carcinoma in the right lobe of the liver. E and F, Hepatocellular carcinoma in a 58-year-old male shows hepatomegaly with diffuse abnormal lesions throughout the liver parenchyma.
Lymphoma was found in this elderly male with hepatomegaly. Multiple isoechoic lesions were found throughout the liver.
