Peds- Liver Flashcards
1
Q
When imaging perdiatric liver all adult landmarks must be acquired including?
A
- PV
- PV bifurcation
- CHA
- CBD
- HV’s
- biliary tract
2
Q
Liver on U/S?
A
- homogenous
- more echogenic than kidneys
- doppler to see bile ducts
- functional vs. segmental division
3
Q
4 benign liver tumors?
A
- hemangioma
- mesenchymal hamartoma
- adenoma
- focal nodular hyperplasia
4
Q
3 types of hemangioma?
A
- infantile
- hemangioendothelioma
- cavernous hemangioma
5
Q
5 malignant liver tumors?
A
- hepatoblastoma
- HCC
- fibrolamellar HCC
- mesechymal (embryonal) sarcoma
- metastases
6
Q
what is hemangioma?
- common or uncommon?
- arise from?
- most common?
A
- rare
- arise from AV malformations
- most common heptatic mass in neonate
7
Q
what is the most common hepatic mass in neonate?
A
hemangioma
8
Q
what is hemangioendothelioma?
A
- blood filled spaces with multilayered endothelium
9
Q
what is cavernous hemangioma?
A
- single layered endothelium
10
Q
who does hemangioendothelioma mainly affect? what is it associated with?
A
- affects infants less than 6 months of age
- associated with skin hemangiomas
11
Q
clinical presentations of hemangioendothelioma?
- symptomatic
- asymptomatic
A
symptomatic:
- hepatomegly
- congestice heart failure
- hemoperitoneum from rupture
asymptomatic
- causes may undergo complete involution
12
Q
Hemangioendothelioma sono features?
A
- single or mulltiple
- varying echo and size
- contains fine linear foci of calcium
- may have enhancement
- vascular
13
Q
Cavernous Hemangioma?
- mainly found in?
- age?
- usually found how?
A
- 3x more likely in girls
- evident by 2 months of age
- usually found incidentlly
14
Q
Cavernous Hemangioma clinical presentation?
A
- large hemangiomas may cause:
- hepatomegly (palpable)
- obstructive jaundice
- bowel obstruction (vomiting)
- respriratory insufficiency
15
Q
cavernous hemangioma treatment?
A
- varies with size of mass
- usually regresses
- lobectomy or resection if needed
16
Q
sono features Cavernous Hemangioma?
A
- well defined
- hyperechoic (multiple interfaces between walls of blood-filled vessels)
- can be hypoechoic (atypical)
- enhancement
- vascular
- may calcify with PAS
17
Q
what is mesenchymal hamargtoma?
A
- rare
- congenital
- arises from connective tissue of the portal tracts
18
Q
Mesenchymal Hamartoma clinical presentation?
A
- painless abdominal swelling
19
Q
Mesenchymal Hamartoma sono features?
A
- resembles hemangioma but avascular
20
Q
Mesenchymal Hamartoma treatment?
A
- resection
- excellent prognosis
21
Q
adenoma is highly associated with?
A
- glycogen storage disease
22
Q
adenoma sono apperance?
A
- hyper or hyopechoic
23
Q
FNH?
A
rare in children
24
Q
FNH sono features?
A
- isoechoic
- doppler- blood in centre of lesion
25
what fraction of solid pediatric liver tumors are malignant?
2/3
26
Most common pediatric liver mass?
heptaoblastoma
27
Hepatoblastoma is most common in?
boys younger than 5
28
Hepatoblastoma clinical presentation?
- hepatomegaly
- painless, palpable abdominal mass
Advanced cases:
- fever
- weight loss
- pain
- nausea and vommiting
- jaundice
- anemia
29
Hepatoblastoma lab values?
- increased AFP
| - increased LFT
30
Hepatoblastoma treatment?
- resection if it occupies one lobe and didn't invade portal vein
- chemotherapy improved operability
31
Hepatoblastoma sono features?
- Solitary multinodular mass
- Heterogeneous
- Hyperechoic
- ill-defined borders
- Areas of necrosis and hemorrhage
- Calcifications
32
HCC (hepatoma) affects? associated with (3)?
- affects children older than 3 years of age
associated with:
- glycogen storage disease
- wilson's disease
- hepatitis
33
HCC (Hepatoma) clinical presentation?
- sudden liver failure due to thrombosis of portals or HVs
- hepatomegaly
- pain
- GI bleeding, anemia
- ascites
34
HCC (hepatoma) lab values?
- increased AFP
| - Hypoglycemia
35
HCC (hepatoma) sono features?
- similar to Hepatoblastoma
- solid hyperechoic mass involving the entire liver
- well-defined or ill-defined borders
- anechoic areas within mass from necrosis
- hypo-anechoic halo around mass
36
What is Fibrolamellar HCC? who does it mainly affect?
- Histologic subtype of HCC
| - affects teenagers ad young adults
37
Fibrolamellar HCC clinical presentation?
- abdominal pain
- mass, fever, weight loss
- diarrhea
- vomiting
38
Fibrolamellar HCC lab values?
AFP normal or mildly elevated
39
Fibrolamellar HCC sono features?
- solitary well0 marginated
- variable echogenicity
- focal calcifications
40
What is Mesenchymal Sarcoma? how does it mainly affect?
- rare
- 5-10 year old
- fast growing tumor
41
Mesenchymal Sarcoma clinical presentations?
- abdominal pain
- swelling
- palpable mass
- AFP normal
42
Mesenchymal Sarcoma sono features?
- single
- round, well-defined
- variable echogenicity with anachoic/ cystic spaces creating enhancement
43
Metastases is usually associated with? (4)
1. neuroblastoma
2. wilm's tumor
3. leukemia
4. lymphoma
44
most common cause of metastases in children?
neuroblastoma
45
Metastases non features?
- variable apperance
| - multiiple masses
46
infectious and inflammatory diseased of the liver? (2)
1. hepatitis
| 2. abscess
47
3 kinds of abcesses?
1. amebic abscess
2. pyogenic abscess
3. fungal abscess
48
what is hepatitis?
- viral?
- non viral?
- diffuse infaction of the liver
- inflammation and necrosis of hepatic cells
almost all cases are viral:
- A, B, C, D, E, CMV, herpes
non-viral causes:
- toxins
- drugs
49
hepatitis symptoms?
- hepatomegly with pain
- jaundice
- nausea
- fever
- loss of appetite
50
chronic hepatitis symptoms?
- cirrhosis
- liver damage
- cancer
51
hepatitis sono apperance?
- hyper or hypoechoic
- hepatomegly
- prominent portal vein
52
liver abscess results from?
- neonatal infection from the umbilicus or surgery
- seeded into liver through the portal or umbilical vein
- high mortality rate
53
liver abscess treatment?
- antibiotic therapy
- drainage
- surgery
54
who does amebic abscesses affect?
- children in areas where drinking water is contaminated and sanitation is poor
55
amebic abscess enters body? forms?
- enters the liver from colon through portal system
| - forms a cavity in liver and becomes abscess
56
Amebic Abscess lab values?
- mildly elavated LFT's
- anemia
- leukocytosis
57
Amebic Abscess clinical presentation?
- abdo distention
- fever
- RUQ pain
58
Amebic Abscess cono features?
- hypoechoic spherical lesion
| - right lobe
59
What is Pyogenic Abscess?
- rare
- can be fatal in children
- E.coli / Klebsiella pneumoniae
- Immunocompromised children
60
Pyogenic Abscess sono features?
- discretely marginated hypoechoic structures with enhancement
- complex hyperechoic with poorly defined walls
- if contains gas – shadowing and reverberation artifacts
- bull’s eye appearance
61
What is Fungal Abscess?
- immunocompromised children
| - cansisa albicans
62
Fungal Abscess sono features?
- multiple small lesions
- irregular walls
- round and hypoechoic
- target or wheel within a wheel appearance
63
Diffuse Liver Disease examples (3)?
- fatty liver
- cirrhosis
- hepatic fibrosis
64
fatty infiltration is caused by?
- chronic hepatic injury and results from an accumilation of abnormal triglycerides and lipids
- can be diffese or focal
65
fatty infiltration associates with?
- many pathological conditions
- child obesity
- can be reversable
66
Diffuse Fatty Infiltration sono features?
- mild
- moderate
- severe
- large and echogenic liver with decreased visualization of hepatic veins
Mild - increased echo
Moderate - increased echo, decreased penetration, faint visualization of vasculature
Severe - unable to penetrate liver, no visualization of vasculature
67
focal fatty infiltration sono features?
- distinct areas of increased echogenicity
- mimics mass without mass effect
- does not change the contour of the liver
68
What is cirrhosis?
- parenchymal destruction, scarring, fibrosis, and nodular regeneration
69
cirrhosis is due to?
```
Biliary atresia
Cystic fibrosis
Chronic hepatitis
Metabolic dx
Budd-Chiari syndrome
Medications
```
70
cirrhosis clinical presentation?
- hepatomegaly (early stages)
- jaundice
- ascites
71
cirrhosis lab tests?
mildly increased:
- AST
- ALT
- LDH
- direct and indirect bilirubin
72
Cirrhosis u/s features?
```
Small liver (late stage)
Surface nodularity
Coarse/heterogenous echo
Increased echo
Signs of ascites, splenomegaly, portal hypertension
```
73
Hepatic fibrosis?
- rare
- associated with ARPKD
- excessive connective tissue build-up due to chronic injury
74
Hepatic Fibrosis clinical presentations?
- hepatomegaly
| - portal hypertension
75
Hepatic Fibrosis sono features?
- increased echogenicity of liver
| - biliary dilatation
76
Hepatic Vascular Disorders (4)?
Portal Hypertension
Portal Vein Thrombosis
Budd-Chiari*
Hepatic Infarction
77
Portal Hypertention?
- increased resistance to normal portal flow
78
Portal Hypertention clinical presentation?
- splenomegly
- ascites
- caput medusa
severe cases:
- hematemesis
- hepatic encephalopathy
79
Portal Hypertension types of obstruction?
- prehepatic
- PV or SV thrombosis
- intrahepatic (cirrhosis)
- posthepatic (heart conditions)
80
Portal Hypertension sono features?
- Hepatofugal portal flow
- Varices
- Splenomegaly
- Ascities
- Cirrhosis
81
Portal Vein Thrombosis caused by?
- thrombosis due to dehydration, catheterization, shock, portal hypertension
OR
- tumor invasion from HCC or hepatoblastoma
82
Portal Vein Thrombosis clinical presentation?
- acute abdo. pain
| - splenomegaly
83
Portal Vein Thrombosis sono features?
- Enlarged, echogenic portal veins
- Absent doppler
- Visualization of tumor invasion
- Cavernous transformation (in chronic PVT)
- Acute PVT can mimic normal portal vein on grey scale
- Collaterals
84
What is Budd-Chiari syndrome?
Clinical features of hepatic venous outflow obstruction
85
Budd-Chiari syndrome causes? (3)
1. idiopathic occlusion
2. neoplastic invasion
3. thrombosis
86
Budd-Chiari syndrome sono?
- primary findings?
- secondary findings?
Primary findings:
- Hepatomegaly
- Echogenic clot in HVs
- Absence of flow in HVs
Secondary findings:
- Ascites
- Pleural effusion
- GB wall edema
87
Hepatic Infarction?
Rare due to liver’s dual blood supply
| Can occur with hepatic artery occlusion
88
Hepatic Infarction sono?
- Wedge-shaped, round or oval area of decreased echogenicity
- Good margins
- Changes from hypo to hyper to calcification over time
89
Hepatic Trauma?
- Liver is the most commonly injured abdominal organ in blunt abdominal trauma in children
- Hemoperitoneum
- Hematomas in liver change with time and vary in echogenicity
- Anechoic to complex with possible calcifications
90
4 types of hepatic trauma?
1. subcapsular
2. parenchymal
3. lacerations
4. fractures
91
Hepatic Cysts?
- Congenital cysts are rare
- Associated with multicystic kidney disease and Von Hippel Lindau disease
- Can be acquired via trauma
92
Hepatic Cysts clinical presentations?
- asymptomatic
| - unless cyst is large- than palpable
93
Hepatic Cysts sono?
- smooth-walled
- anechoic
- enhancement
- attaches by stalk
94
Hydatid echinococcal cysts?
Parasitic (tapeworm)
| Echinococcus
95
Hydatid echinococcal cysts causes?
- Exposure to livestock, farming, dogs
| - Parasite reaches liver from intestines through PV
96
Hydatid echinococcal cysts sono?
- Simple cyst
| - Complex cyst (daughter cysts, septa, debris, floating membranes)
97
Hydatid echinococcal cysts Clinical signs?
- Urticaria
- RUQ pain
- Hepatomegaly
- Lungs, brain, kidneys can be affected
- Rupture of cyst to peritoneum – anaphylactic shock
