Sonographic Findings (Liver, Gallbladder & The Bile Ducts)

Question 1

Diffusely echogenic liver, increased attenuation of the sound beam, and wall of the hepatic vasculature and diaphragm will not be easily imaged

Answer 1

Diffuse fatty liver disease

Question 2

Hyperechoic area adjacent to the gallbladder, near the porta hepatis, or part of a lobe may appear echogenic

Answer 2

Focal fatty infiltration

Question 3

Hypoechoic area adjacent to the gallbladder, near the porta hepatis, or part of a lobe or an entire love may be spared, and can appear much like pericholecystic fluid when identified adjacent to the gallbladder

Answer 3

Focal fatty sparing

Question 4

Normal liver, enlarged, hypoechoic liver, periportal cuffing “starry sky”, and galbladder wall thickening

Answer 4

Hepatitis

Question 5

Hepatosplenomegaly (initial), shrunken, echogenic right lobe of the liver, enlarged caudate and left lobes, nodular surface irregularity, coarse echotexture, splenomegaly, ascites, monophasic flow within the hepatic veins, and hepatofugal flow within the portal veins

Answer 5

Cirrhosis

Question 6

(Starts the same as cirrhosis), enlargement of the main portal vein and superior mesenteric vein, enlargement and reversed flow within the coronary vein, enlarged hepatic arteries, abdominal varicosities at the splenic hilum, renal hilum, and gastroesophageal junction, and patent paraumbilical vein (recanalized paraumbilical vein)

Answer 6

Portal hypertension

Question 7

Echogenic thrombus within the portal vein and cavernous transformation of the portal veins will appear as wormlike or serpiginous vessels within the region of the portal vein

Answer 7

Portal vein thrombosis

Question 8

Small, bright reflectors noted within the circulating blood inside the portal vein, and larger air collections may produce ring-down artifact

Answer 8

Portal venous gas

Question 9

Nonvisualization or reduced visualization of the hepatic veins, thrombus within the hepatic veins, enlarged caudate lobe, lack of flow within the hepatic veins with color Doppler, and narrowing of the IVC

Answer 9

Budd-Chiari syndrome

Question 10

Anechoic mass or masses with posterior enhancement, may have irregular shapes, and clusters of cysts may be noted

Answer 10

Hepatic cysts

Question 11

Anechoic mass containing some debris, “water lily” sign appears as an endocyst floating within the pericyst, “mother” cyst containing one or more smaller “daughter” cyst, and masses may contain some elements of dense calcification

Answer 11

Hydatid liver cyst

Question 12

Round, hypoechoic or anechoic mass or masses, may contain debris (with fluid-debris layering), and acoustic enhancement

Answer 12

Amebic hepatic abscess

Question 13

Complex cyst with thick walls, mass may contain debris, septations, an/or gas, and the air within the abscess may produce dirty shadowing or ring-down artifact

Answer 13

Pyogenic hepatic abscess

Question 14

Multiple masses with hyperechoic central portions and hypoechoic borders (target, halo, or bulls-eye lesion), these masses are typically 1 cm or smaller in size, and older lesions may calcify

Answer 14

Hepatic candidiasis

Question 15

Small, hyperechoic mass, typically found in the right lobe

Answer 15

Cavernous hemangioma

Question 16

Isoechoic, hyperechoic, or hypoechoic mass, central scar may appear as hyperechoic or hypoechoic linear structure within the mass and will often reveal hypervascularity with color Doppler

Answer 16

Focal nodular hyperplasia

Question 17

Mostly hypoechoic, may be hyperechoic, isoechoic, or be comprised of mixed echogenicities

Answer 17

Hepatocellular adenoma

Question 18

Hyperechoic mass

Answer 18

Hepatic lipoma

Question 19

Fresh clot may appear hyperechoic, older hemorrhage can appear anechoic or complex, and may be intrahepatic or subcapsular

Answer 19

Hepatic hematoma

Question 20

Solitary, hypoechoic mass, hetergeneous masses scattered throughout the liver, mass with a hypoechoic halo and central echogenic portion (target or bull’s eye), and possible ascites

Answer 20

Hepatocellular carcinoma

Question 21

Hyperechoic, hypoechoic, calcified, cystic, or hetergeneous masses, mass or masses demonstrating a hypoechoic rim and central echogenic region, diffusely heterogeneous liver, and possible ascites

Answer 21

Hepatic metastasis

Question 22

Homogeneous or complex hepatic mass, and may contain calcification or cystic spaces

Answer 22

Infantile hemangioendothelioma

Question 23

Solid, hyperechoic, or heterogeneous mass, and mass may contain calcifications

Answer 23

Hepatoblastoma

Question 24

Echogenic, mobile, shadowing structure(s) within the lumen of the gallbladder, stones that lodge within the cystic duct or neck of the gallbladder may not move, WES sign may be present

Answer 24

Cholelithiasis

Question 25

A collection of low-level, nonshadowing, dependent echoes within the gallbladder lumen

Answer 25

Gallbladder sludge

Question 26

Hyperechoic, nonshadowing, and nonmobile mass that projects from the gallbladder wall into the gallbladder lumen

Answer 26

Gallbladder polyp

Question 27

Focal or diffuse thickening of the gallbladder wall, comet tail artifact that projects from the gallbladder wall into the lumen of the gallbladder

Answer 27

Adenomyomatosis

Question 28

Gallstones, positive Murphy sign, gallbladder wall thickening and enlargement, pericholecystic fluid, sludge

Answer 28

Acute cholecystitis

Question 29

Gallstones, loss of Murphy sign, gallbladder wall thickening with possible perceptible wall tear, focal wall necrosis, bulges of the gallbladder wall, sloughed membranes, and ulcerative craters, gallbladder loses its typically shape, pericholecystic fluid, sludge

Answer 29

Gangrenous cholecystitis and gallbladder perforation

Question 30

Dirty shadowing reverberation, or ring down artifact from gallbladder wall or lumen, champagne sign

Answer 30

Emphysematous cholecystitis

Question 31

Contracted gallbladder, gallstones, WES sign, wall thickening

Answer 31

Chronic cholecystitis

Question 32

Positive Murphy sign, sludge, pericholecystic fluid, gallbladder wall thickening

Answer 32

Acalculous cholecystitis

Question 33

Gallbladder > 4-5 cm in diameter and 8-10 cm in length, search for obstruction (cholelithiasis or pancreatic mass)

Answer 33

Gallbladder enlargement

Question 34

Calcification of gallbladder wall with shadowing, signs of chronic cholecystitis and gallstones may be present

Answer 34

Porcelain gallbladder

Question 35

Diffuse or focal gallbladder wall thickening, nonmobile mss within gallbladder lumen > 1 cm, invasion of the mass into surrounding liver tissue, irregular mass that may completely fill the gallbladder fossa

Answer 35

Gallbladder carcinoma

Question 36

Echogenic foci within bile duct (may or may not shadow), may have biliary dilatation

Answer 36

Choledocholithiasis

Question 37

Biliary sludge, bile duct wall thickening, choledocholithiasis, biliary dilatation

Answer 37

Cholangitis

Question 38

Echogenic linear structures in the ducts that produce ring down artifacts and dirty shadowing

Answer 38

Pneumobilia

Question 39

A worm within the biliary duct (echogenic linear structure), movement of worm (confirmation)

Answer 39

Ascariasis

Question 40

Absent biliary ducts, triangular cord sign

Answer 40

Biliary atresia

Question 41

Cystic mass in the area of the porta hepatis, biliary dilatation

Answer 41

Choledochal cyst

Question 42

Segmental dilatation of intrahepatic ducts, may have renal cystic disease, central dot sign

Answer 42

Caroli disease