URR 18 Flashcards by Billie Harney

____ in the liver shows prominent vascularity that usually starts at a central location with multiple branches extending radially; look s like the spokes on a wheel

Focal nodular hyperplasia

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contrast first fills the central lesion and moves peripherally

centrifugal enhancement

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contrast first pools peripherally in the lesion and then moves centrally

focal nodular hyperplasia

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uncommon tumor, atypical hepatocyte formation

liver cell adenoma

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With a liver cell adenoma, ____ and ___ are absent or few in number

bile ducts
Kupffer cells

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Liver cell adenomas are more common in ___

women

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Liver cell adenomas have a strong association with

oral contraceptives

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Liver cell adenomas can also be also be associated with:

glycogen storage disease

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Clinical symptoms of liver cell adenoma

usually asymptomatic
mass in RUQ

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Liver cell adenoma presents with ____ LFTs

normal

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Liver cell adenoma shows as a ___ nodule on sulfur colloid imaging

cold

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____ is used to characterize adenomas

MRI

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Surgical intervention is recommended for liver cell adenomas due to risk of ____ and ____

hemorrhage
malignant transformation

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hypervascular mass, with/without hemorrhage, in young women taking oral contraceptives

liver cell adenoma

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contrast ultrasound enhancement occurs during arterial phase with washout during portal venous phase

liver cell adenoma

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Hyperechoic mass within the liver, very rare finding

hepatic lipoma

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Hepatic lipomas are associated with:

tuberous sclerosis

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May see propagation speed artifact due to difference in speed of sound in liver tissue and fat; “broken diaphragm” posterior to lesion

hepatic lipoma

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____ is helpful in determining the type of tissue in the hyperechoic mass identified on US

CT scan

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5th leading cause of cancer death

hepatocellular carcinoma

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most common primary malignancy of the liver in adults

hepatocellular carcinoma

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Most common risk factor for hepatocellular carcinoma is

cirrhosis

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With hepatocellular carcinoma, ___% of patients have preexisting cirrhosis

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Hepatocellular carcinoma is also associated with ____

chronic hepatitis

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primary tumor of parenchymal cells that interferes with hepatocyte function

hepatocellular carcinoma

Lab testing for hepatocellular carcinoma

increased LFTs, AST, ALT, ALP

___% of cases of hepatocellular carcinoma have moderate levels of AFP in blood

Clinical symptoms of hepatocellular carcinoma

fever hepatomegaly palpable mass ascites weight loss

What is the tumor called that is associated with hepatocellular carcinoma?

hepatoma

Hepatocellular carcinoma is more common in:

males

Common complicated of hepatocellular carcinoma

biliary obstruction portal hypertension ascites

Hepatocellular carcinoma invades venous vasculature causing blood flow obstruction, most commonly the ____

portal vein

What is the survival rate after detection

3-4 months

What is the 5 year survival rate for hepatocellular carcinoma

can cause a single large mass or multiple masses or diffuse infiltration of cancer cells

hepatocellular carcinoma

Solid nodules in hepatocellular carcinoma measure <__cm

hypoechoic ring surrounding a hyperechoic central area

halo effect

If the ____ is identified around a liver mass, it should create strong suspicion of malignancy

halo sign

Patient history of a primary cancer in the body + liver mass with halo =

liver metastasis

patient history of chronic liver disease + liver mass with halo =

hepatocellular carcinoma

_____ is common in hepatocellular carcinoma

portal venous invasion/thrombosis

With hepatocellular carcinoma, the lesions are:

hypervascular

Hepatocellular carcinoma demonstrates enhancement during the ____ on contrast ultrasound

arterial phase

PW Doppler of intratumor vessels with demonstrate ____ flow with ____ diastolic flow consistent with a low resistant waveform

high velocity increased

Areas of absence of contrast in the arterial phase correspond with areas of ____

necrosis

Contrast washout occurs in the ____ with hepatocellular carcinoma

portal venous

Subtype of HCC in adolescents and young adults with NO coexisting liver disease

fibrolamellar carcinoma

AFP levels in fibrolamellar carcinoma

normal

usually a solitary mass that can grow quite large (6-22 cm), well differentiated and usually encapsulated by fibrous tissue; punctate calcifications and central echogenic scar

fibrolamellar carcinoma

#1 pediatric primary liver malignancy

hepatoblastoma

Hepatoblastoma usually occurs before the age of __

Hepatoblastoma is associated with ___ or ____

Beckwith Wiedemann Syndrome Familial Adenomatous Polyposis

Clinical symptoms of hepatoblastoma

abdominal enlargement hepatomegaly palpable mass

Lab testing associated with hepatoblastoma

abnormal LFTs increased AFP

solid echogenic mass, may have some cystic portions/septations, may contain calcifications, has the tendency to invade hepatic and portal veins

hepatoblastoma

#1 site for metastasis

liver

Metastasis is __X more common than primary liver cancer

Most common solid mass of the liver

metastasis

Common primaries that metastasize to the liver

GI tract (#1) pancreas breast lung ovary

50% of primary cancers that metastasize to the liver are "carried" to the liver by the ____

portal vein

Clinical symptoms of metastasis

RUQ pain weight loss ascites jaundice palpable mass nausea vomiting

Lab testing associated with metastasis

increased LFTs, alkaline phosphatase, AFP, direct bilirubin

Contrast ultrasound will demonstrate rapid contrast washout in the _____ phase

portal venous

Metastasis shows ____ at the center of the lesion as the blood supply is outgrown

necrosis

A liver mass with a _____ is usually a metastatic lesion, less commonly HCC

hypoechoic rim

Hyperechoic lesions within the liver are usually related to:

GI tract primary or HCC secondary

Hyperechoic lesions with hypervascularity within the liver are usually related to:

renal cell carcinoma

Cystic lesions within the liver are usually associated with

sarcoma

The "Bulls-eye" appearance in the liver is nonspecific, but is usually related to:

lung or colon primary

Hypoechoic lesions within the liver are usually related to:

lymphoma lung breast primary

Infiltrative pattern within the liver is usually related to:

breast lung melanoma primaries

Calcifed lesions within the liver are usually related to

mucinous adenocarcinoma of the colon

Potential areas for abnormal lymph nodes in the abdomen:

para-aortic at splenic hilum at renal hilum at porta hepatis

Malignancy of the connective tissue in the body

Kaposi Sarcoma

Kaposi sarcoma may also involve the ___. ___ ___ and other organs

skin lungs GI tract

Most common liver malignancy seen with HIV/AIDS

Kaposi Sarcoma

Type of cancer commonly associated with HIV/AIDS

lymphoma

malignancy of the lymphatic system

lymphoma

Lymphoma sonographic appearance

solid tumor, may be single or multiple, hypoechoic and/or complex appearance

most common variation in hepatic anatomy

accessory right hepatic vein

most common cause of steatosis

obesity

most common chronic liver disease in Western countries

nonalcoholic fatty liver disease

most common chronic bloodborne infection in the US

hepatitis C

most common reason for spread of hepatitis

IV drug users

most common cause of intrahepatic cholestasis

hepatitis

commonly associated finding with hepatitis

cholecystitis

most common causes of hepatic fibrosis are:

hepatitis B and C nonalcoholic steatohepatitis alcoholic abuse

most commonly affects AIDS patients and immunocompromised patients

pneumocystis Carinii

most common causes of granuloma formation

histoplasmosis tuberculosis

most commonly caused by biliary infection

hepatic abscesses

most common liver abscess and most commonly occurs in the right lobe

pyogenic abscess

____ abscess/____ more common in immunocompromised patients

fungal candidiasis

____ abscess formation is most commonly seen in countries outside the US

Amebic

___ cysts are most commonly found in the right lobe of the liver

Hydatid

most common parasitic infection in humans

schistosomiasis

most common causes of cirrhosis

alcoholism hepatitis C

most common cause for micronodular cirrhosis

alcohol consumption

most common cause for macronodular cirrhosis

chronic viral hepatitis

most common benign liver tumor

hemangioma

second most common benign liver mass

focal nodular hyperplasia