Pathology: Liver

Question 1

While scanning the liver in a patient with chronic cirrhosis, you notice a tubular vessel connecting to the splenic vein just prior to its confluence with the SMV. Flow within the vessel is very low velocity, continuous and moving in a cephalic direction. What explains this finding

Answer 1

a dilated coronary vein is present which is a common complication of cirrhosis

Question 2

The most common parasitic infection in humans is

Answer 2

schistosomiasis

Question 3

_______ is the most common malignancy of the liver seen in a patient with AIDS. ______ is the most common infection of the liver seen in a patient with AIDS

Answer 3

kaposi sarcoma, pneumocystis carinii

Question 4

What describes the expected waveform from the hepatic vein in a patient with cirrhosis

Answer 4

monophasic, continuous antegrade flow

Question 5

A patient presents with a history of AIDS and recent pneumocystis carinii infection. What changes to the liver do you expect to see on the ultrasound exam

Answer 5

diffuse echogenic foci throughout the liver tissue

Question 6

Fulminant hepatitis is most commonly caused by

Answer 6

acetaminophen abuse

Question 7

Steatosis refers to

Answer 7

fatty liver disease

Question 8

Hepatic artery hypertrophy is a common finding with

Answer 8

cirrhosis

Question 9

Periportal cuffing is a sign of

Answer 9

acute viral hepatitis

Question 10

What correctly describes peliosis hepatis

Answer 10

blood filled cavities of varied size form in the liver tissue

Question 11

The Ultrasound Liver Imaging Reporting and Data System (US LI-RADS) is used to assess patients at risk for

Answer 11

hepatocellular carcinoma

Question 12

What vessels will be abnormally dilated with significant portal HTN

Answer 12

main portal vein and left gastric vein

Question 13

A resistive index over 0.8 in the common hepatic artery would be an expected finding in patients with

Answer 13

portal htn and transplant rejection

Question 14

Reduced glycogen storage in the liver usually causes the liver parenchyma to have a sonographic appearance similar to

Answer 14

acute viral hepatitis

Question 15

_________ should be suspected in an infant with a large hepatic hemangioma and unexplained thrombocytopenia

Answer 15

kasabach-merritt syndrome

Question 16

Compensatory enlargement of the caudate lobe occurs with which of the following

Answer 16

cirrhosis and budd chiari syndrome

Question 17

What liver tumor is usually treated by surgical resection due to risk of hemorrhage and malignant transformation

Answer 17

adenoma

Question 18

Hypoalbuminemia associated with cirrhosis leads to

Answer 18

gallbladder and bowel wall thickening

Question 19

About 50% of all primary tumors that metastasize to the liver are drained through the

Answer 19

portal vein

Question 20

The hormone changes with pregnancy have been associated with the enlargement of what type of liver mass

Answer 20

hemangioma

Question 21

A patient is referred for a RUQ scan due to the possibility of a fungal infection of the liver. They have a 4yr history of treatment for AIDS. The liver demonstrates diffuse presentation of multiple calcifications of different sizes, with and without shadowing. These findings are most consistent with

Answer 21

pneumocystis carinii

Question 22

What type of liver abscess presents as a mass with internal septations similar to the spokes of a wheel

Answer 22

fungal

Question 23

Portalization of the hepatic veins is a common finding in which of the following

Answer 23

advanced cirrhosis

Question 24

If a liver transplant has a piggyback anastomosis, how does this affect your evaluation

Answer 24

there will be a single anastomosis site in the IVC that must be evaluated

Question 25

If a liver transplant has a piggyback anastomosis, how does this affect your evaluation

Answer 25

there will be a single anastomosis site in the IVC that must be evaluated

Question 26

What is caput medusa

Answer 26

tortuous vessels around the umbilicus caused by portal HTN

Question 27

A liver mass with a hypoechoic rim should create a strong suspicion of

Answer 27

malignancy

Question 28

What condition is associated with prominent portal walls

Answer 28

acute viral hepatitis

Question 29

What is commonly associated with contaminated water and causes debris/occlusion within intrahepatic portal venous system

Answer 29

schistosomiasis

Question 30

_______ usually presents as multiple target lesions in the liver

Answer 30

metastasis

Question 31

A 6 month old female is referred for an abdominal ultrasound due to suspected kasabach-merritt syndrome. What are you looking for on the exam

Answer 31

liver or spleen hemangioma formation

Question 32

What would cause an increase in serum AST levels with normal serum ALT levels

Answer 32

congestive heart failure

Question 33

Placement of a Linton or Warren shunt is a method used to

Answer 33

reduce portal hypertension

Question 34

What is a potential collateral pathway formed in patients with cirrhosis

Answer 34

blood moves fom the coronary and short gastric veins into the esophageal veins

Question 35

You are scanning through the liver and note the caudate lobe is nearly the same size as the right lobe. The surface of the liver appears lobulated or nodular. What is most likely the diagnosis of these findings

Answer 35

cirrhosis

Question 36

A patient presents with an isolated slight increase in liver function tests. You identify two hyperechoic, homogeneous masses in the area of the prota hepatis. These findings are most consistent with

Answer 36

focal fatty infiltration

Question 37

A vascular condition of the liver seen in women who take oral contraceptives is

Answer 37

budd chiari syndrome

Question 38

WHat is a potentially life threatening complication of portal HTN

Answer 38

ruptured gastroesophageal varices

Question 39

What liver complication is associated with cholangitis, diverticulitis and osteomyelitis

Answer 39

pyogenic abscess

Question 40

What is most likely to demonstrate a simple cyst with gravity dependent debris in the right lobe of the liver

Answer 40

early echinococcal infection

Question 41

What is true regarding a transjugular intraheptic shunt

Answer 41

air is retained within the shunt after placement which limits the US evaluation for the first 3-5 days

Question 42

The diamter of the __________ will be relatively unaffected by hepatic congestion

Answer 42

heaptic artery

Question 43

What is the most common cause of a hepatic abscess in the US

Answer 43

cholangitis and cholecystitis

Question 44

If tardus parvus waveforms are identified in the intrahepatic artery waveforms of a transplant, this finding is ________. If biphasic waveforms are identified in the right and left hepatic arteries, the finding is _______.

Answer 44

suspicious for hepatic artery stenosis, suspicious for organ rejection

Question 45

A patient presents with abdominal pain for 3 months following a missionary trip to India. Lab values demonstrate normal LFTs. The US exam demonstrates a 3cm cyst with septations in the right lobe of the liver. These findings are most consistent with

Answer 45

hydatid cyst

Question 46

What liver disorder leads to the sonographic appearance of hepatomegaly with decreased echogenicity and scattered bright portal reflections within the parenchyma

Answer 46

acute viral hepatitis

Question 47

What describes the Doppler appearnce of liver transplant rejection

Answer 47

high resistance flow in the hepatic artery

Question 48

A patient presents with a history of hep c and you identify a solid liver mass with a hypoechoic halo. This finding is most consistent with

Answer 48

hepatocellular carcinoma

Question 49

How can a hepatic adenoma be differentiated from focal nodular hyperplasia on contrast enhanced ultrasound

Answer 49

FNH lesions usually demonstrate centrifugal enhancement while adenomas demonstrate centripetal enhancement

Question 50

The most common finding with congestive hepatomegaly is

Answer 50

IVC dilatation

Question 51

What finding indicates a failed transjugular intrahepatic shunt

Answer 51

hepatofugal flow in the main portal vein

Question 52

Triglyceride accumulation in the liver leads to ______, while copper accumulation in the liver leads to ______

Answer 52

steatosis, wilson disease

Question 53

___________ is the most common cause for micronodular cirrhosis and ____________ is the most common cause of macronodular cirrhosis

Answer 53

alcohol consumption, chronic viral hepatitis

Question 54

A mass that presents with a bull's eye appearance within the liver tissue is most likely

Answer 54

metastasis

Question 55

The primary finding that differentiates liver mass formation from steatosis is

Answer 55

steatosis will demonstrate normal vessel course through affected areas, while mass formation displaces vasculature

Question 56

High-intensity transient signals (HITS) are seen on the doppler evaluation of a patient with

Answer 56

portal venous gas

Question 57

What is the most common primary ccancer to metastasize to the liver

Answer 57

GI tract

Question 58

What abnormality causes focal development lesions of the liver and is associated with congenital hepatic fibrosis, autosomal dominant polycystic disease and cholangiocarcinoma

Answer 58

biliary hamartomas

Question 59

A TIPS shunt is placed into the liver circulation to alleviate portal HTN. What two vessels are usually connected

Answer 59

right portal vein connects to the right hepatic vein

Question 60

________ is the most common liver malignancy, while ________ is the most common primary liver malignancy

Answer 60

metastasis, hepatocellular carcinoma

Question 61

What is the most common cause for intrahepatic cholestasis

Answer 61

hepatitis

Question 62

Liver hemangiomas are a sommon benign neoplasm that will usually appear on an US of a normal liver as

Answer 62

well defined, hyperechoic liver mass

Question 63

A cyst within a cyst (daughter cyst) is a classic sign of

Answer 63

hydatid cyst or echinococcal cyst

Question 64

Alcoholic cirrhosis demonstrates a severe increase in ______, while viral hepatitis demonstrates a severe increase in _______

Answer 64

AST, ALT

Question 65

What metabolic infiltrative disorder is associated with hepatic adenoma formation

Answer 65

von gierke disease