REVIEW - Liver Flashcards
most common cause of hydatid disease
parasite - sheep cattle
sono appearance hydatid liver disease
cystic mass with smaller daughter cysts, lily-pad
most common benign tumour of liver
cavernous hemangioma
sono appearance hemangioma
homogenous, hyperechoic <3cm, hypovascular
what causes increased echogenicity of hemangioma?
numerous interfaces between walls of cavernous sinuses and blood within
is colour dop useful for hemangioma?
no, flow too slow
D/D when hemangioma is seen (2)
mets from colon/GI
HCC
if you’re differentiating between colon mets or HCC what would lab values or history indicate for either?
HCC- cirrhosis/hepatatis
colon mets - LFT increased
what lesion associated with bleeding/hemorrhage
adenomas
sono appearance adenoma
solitary, encapsulated, LARGE, hypo/iso/hyper
Complex due to hemorrhage; sono changes with duration of bleeding. at first echogenic –> after 1 week more hypo
why is resection of adenomas rec.?
hemorrhage risks and malignant degeneration
second most common benign tumour
FNH
sono app FNH
iso/hyper/hypo
stellate vascular pattern/spoke of wheel
central scar
assoc with OC (2)
adenomas
FNH
causes of fatty liver disease (you may not think)
pregnancy
cystic fibrosis
chemo
toxins
t/f fatty liver is not reversible
false
what changes from mild to severe fatty liver disease?
minimal diffuse increase in hepatic echogenicity to marked increase in echogenicity. poor penetration to posterior liver
important to image right kidney/liver interface
to compare echogenicity
3 mechanisms that combine to create cirrhosis
cell death
fibrosis
regeneration
most common cause of micronodular form of cirrhosis
alcohol consumption
most common cause of macronodular form of cirrhosis
chronic viral hepatitis
classic clinical presentation of cirrhosis (3)
hepatomegaly
jaundice
ascites
sono features of ascites (5)
volume redistribution (early-large, advanced - small)
coarse echotexture
nodular surface
portal hypertension
portal hypertension assoc with (3)
ascites
varices
splenomegaly
most common malignant liver tumour
HCC
two most common predisposing causes of HCC
alcoholism
hepatitis
what does HCC invade (2)
portal vein
hepatic vein
most common primary tumours that result in liver mets (6)
GB colon stomach panc breast lung
what structures aid in the spread of disease
blood born- HA or PV
lymphatics - stomach, panc, ovary, uterus
D/D for hyperechoic lesions in the liver other than mets?
hemangiomas (mets from colon hyperechoic)
echogenic mets tend to arise from
GI tract/colon
HCC
Hypoechoic mets arise from
Breast, lung, gastric, panc, esophageal
Bulls eye mets
Lung
8 causes hepatomegaly
alcohol abuse hepatitis fatty infiltration mononucleosis hemochromatosis primary liver cancer leukemia lymphoma
3 stages of hematoma sono app
<24 hr echogenic
within 1st week hypo
2-3 wk indistinct, tissue granulation
what am I: not on medication, single avascular hyperechoic lesion
hemangiomas
what am I: incidental lesion, colour doppler indicated spoke wheel pattern Hx OC use
FNH
what am I: OC, hypervascular, palpable
adenoma
what am I: 50 yr old man, underdeveloped country, increased LFTs
hydatid disease
what am I: fever, abdo pain, nausea, vomit, jaundice, leukocytosis, starry night sign
Hepatitis
chronic hep can lead to
Cirrhosis
portal hypertension
HCC
Fecal-oral route - which hepatitis?
A
What am I: recent cholecystectomy following a bout of cholecystitis. presented with fever, malaise, anorexia, RUQ pain. Leukocytosis.
abscess
what may be present with abscess?
gas - echogenic foci with artifact
what am I: pt c/o distended abdo S/S hepatomegaly, jaundice. denies alcohol abuse. increased LFTs
cirrhosis
causes of cirrhosis
alcohol primary, then Hep C
w/a
immunosuppressed
candidiasis - multiple small abscesses
w/a
bright periportal walls
hepatitis
w/a
dilated portal tracts
schistosomiasis
w/a
2nd most commonly benign liver lesion
FNH
w/a
reversible metabolic disease
steatosis
w/a
broken diaphragm sign
fatty tumour
w/a
aurora sign
lung parenchymal disease
w/a
collection of blood following trauma
hematoma
w/a
gas producing bacteria in a collection
abscess
w/a
focal mass on cirrhotic liver
HCC
w/a
most common parasitic disease
schistosomiasis
w/a
most common benign liver mass
hemangioma
w/a
periportal hypoarea on fatty liver
focal sparing
w/a
brightly echogenic enlarged liver
diffuse fatty infiltration
w/a
anatomic variant seen in women
reidels lobe
w/a
nodular liver with irregular contour
cirrhosis
w/a
anechoic, smooth walls, posterior enhancement
simple cyst
w/a
daughter cyst
hydatid disease
