Surgery Case - Hepatic Mass

Question 1

Common malignant liver tumors?

Answer 1

HCC
Cholangiocarcinoma
Mets

Question 2

Common benign focal liver lesions?

Answer 2

Cysts - congenital, parasitic (echinococcal)
Cavernous hemangiomas
Focal nodular hyperplasia
Hepatic adenoma
Abscesses

Question 3

Useful imaging modalities for liver mass?

Answer 3

CT
MRI
U/S

Question 4

Best imaging modality to evaluate liver masses?

Answer 4

CT (can identify other intra-abdominal pathology, vascular involvement with CT angio)

Question 5

When is U/S useful for evaluating liver masses?

Answer 5

Intra-operatively
Doppler can help demonstrate vascularity
Carcinoma can be recognized as discrete nodules

Question 6

When is MRI useful for evaluating liver masses?

Answer 6

Vascular involvement, additional intra-abdominal lesions

Question 7

Imaging findings of hepatoma on CT?

Answer 7

Single or multiple masses or diffuse involvement
-Low attenuation lesion
-Hemorrhage, fat, necrosis, calcification, hypodense capsule or rim, enhancement seen with contrast
Can invade portal and hepatic veins

Question 8

Findings of liver cyst on CT?

Answer 8

Oval, well-defined
Imperceptible or thin wall
Water density
No enhancement

Question 9

U/S findings of liver cyst?

Answer 9

Well-defined, anechoic, may be echogenic due to fluid content

Question 10

MRI findings of liver cyst?

Answer 10

T1 hypointense

T2 marked hyperintensity

Question 11

Imaging procedure of choice to evaluate liver for mets?

Answer 11

CT (triphasic)

Question 12

Findings of fatty degeneration and liver scarring on CT?

Answer 12

Lower density than spleen
Lacelike pattern )(fibrosis)
Heterogeneity of liver parenchyma
Regenerative nodules (enhance during portal venous phase)

Question 13

Findings of cirrhosis on CT?

Answer 13

Surface nodularity
Hypertrophic left lobe
Atrophic right lobe