Module 3 Chapter 12: Approach to Liver Masses

Question 1

Liver masses can be:

Answer 1

cystic, solid, benign, or malignant, or mixes of both

Question 2

name simple benign cystic disorders that cause liver masses

Answer 2

polycystic liver disease (can be so many cysts that they can have portal hypertension or early satiety)

• simple cyst– could be drained
• caroli’s diseae: inherited disorder charactereized by dilation of the intraheaptic bile ducts

Question 3

name benign complex infectious and proliferative cystic causes of liver mass

Answer 3

benign –> complex –> infectious (hydatic cysts, reat with PAIR therapy; Percutaneous Aspiration, Injection (3% normal saline to kill parasite), followed by Re-
aspiration)

complex –> proliferative (cystadenoma) –> can lead to cystadenocarcinma

Question 4

malignant cystic liver mass

Answer 4

cystadenocarcinoma

Question 5

oultine solid benign proliferative liver mass causes

Answer 5

hemangioma,

FNH– focal nodular hyperplasia – Made up of all normal liver components of liver (including normal hepatocytes and Kupffer
cells) growing in an aberrant manner

Adenoma– They are composed of abnormal hepatocytes and can rupture, bleed or undergo malignant
transformation (to HCC), especially if >5cm

Question 6

outline solid, benign, infectious causes of liver mass

Answer 6

abcess– may have fever. usually due to gram negative bacillus or / anaerobes from an obstructed biliary system

Question 7

outline types of cysts

Answer 7

1) Simple cysts (arrows) on US
2) Complex cysts due to Echinococcus with daughter cysts (arrow) on CT–HYDATID CYSTS
3) Liver abscesses with ring enhancement (arrows) on CT
4) Hemangioma with puddling of contrast at periphery (arrow) on CT
5) Focal Nodular Hyperplasia (FNH) with central scar (arrow) on MRI
6) Adenoma complicated by hemorrhage (arrow) on CT

Question 8

what is the primary liver cancer

Answer 8

hepatocellular carcinoma

or

intrahepatic cholangiocarcinoma

Question 9

a solid liver mass may be malignant due to primary liver cancer or metastasis. How can you tell if its a metastasis?

Answer 9

may be seen by having rapid washout of contrast.

• mets may be solitary or multiple. Cancers can spread to the liver due to its rich blood supply.

Question 10

name these simple cysts

Answer 10