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Friday 15 April 2011

Focal leasions in the liver





Hemangioma in the live:

In the 7th segment of the liver, a 13 mm rounded echogenic area is seen, elsewhere the liver is homogeneous.
- Dont`t confuse with focal fatty infiltration of the liver usually seen arround the GB, or the echogenic ligamentum teres.
- A hemangioma can be echogenic or isoechoic.
- Smooth margins, round or oval in shape.
- Often multiple, may contain calcifications, rarely has a peripheral rim.
- Unlike FNH hemangiomas are vascularised in a peripheral-to-central pattern => aka iris diaphragm sign.


CEUS:

Arterial phase (20-30 sec): outer portions enhance, center remains hypoechoic.
Portal phase (40-100 sec): central portions become increasingly echogenic.
Venous phase (110-180 sec): the entire leasion is hypoechoic.


LINKS:

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Hepatic cyst

Differential diagnosis for cystic leasions:
inflammatory, infectious (echinococciasis, abscess), traumatic (hematoma), neoplastic (cyst-like mets, regressive necrotic liquified mets).

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Echinoccocal cyst: anechoic, round, echogenic wall, calcifications in cystic echinococcosis.

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Hematoma: irregular in shape, no wall, has low level internal echos
Traumatic liver rupture with hematoma

Subcapsular hematoma - US
Subcapsular hematoma - CT

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Abscess: irregular in shape, no wall, internal echos
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Cyst-like mets:



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Hepatic tumors
 Object name is WJR-2-215-g001.jpg
A: Illustration of morphologic patterns of hepatic tumors in the B-mode ultrasonography; B: Illustration of enhancement patterns of hepatic tumors in the arterial phase
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HYPOECHOIC CHANGES:



Focal sparing in fatty infiltration:

- Mostly seen in periportal region next to GB or lig. Trias
- Elliptical or triangular
- May occasionally show a patchy or flame like distribution in the liver

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Focal Nodular Hyperplasia

- The 2nd most common bening liver tumor after hemangioma
- It is usually asymptomatic, rarely grows or bleeds, and has no malignant potential. This tumour is often resected because it is difficult to distinguish from hepatic adenoma.
- Hypoechoic round or elliptical
- Smooth margins
- Heterogeneous echo-pattern due to central scarring
- Echogenic extensions radiating to periphery (stellate scar)
- CDS: vessels passing through the radial connective tissue (spoked wheel pattern)


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Adenoma:

- Resembles FNH in B mode US
- Made up from hepatocytes, and vessels
- Isoechoic or hypoechoic
- Smooth margins
- Pseudocapsule or hypoechoic rim
- Small internal echos if has hemorrhage
- CDS: well vascularised, characteristic vascular pattern, feeding artery can be seen


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Hepatocellular carcinoma (HCC):

-Variable appearance
- Hypoechoic, isoechoic, hyperechoic, nonhomogeneous
- Solitary or isolated
- In cirrhotic liver
- Frequent regressive changes (hemorrhage, calcifications)
- CDS: increased vascularisation, no typical pattern of arrangement


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Cholangiocellular carcinoma:

- Diffuse growth
- Isoechoic or sometomes hypoechoic (due to scarring)
- Regional mets with ascites



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Hematologic malignant systemic diseases:

- Micronodular malignant systemic diseases (CML), or macronodular lesions ( high grade lymphomas, lymphogranulomatosis)
- Intensly hypoechoic without a peripheral halo
- Accompanied by othe intra-abdominal sites of LN infiltration


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Other images:

Two hyperechoic leasions in the liver.



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LINKS:

(Text main source: Teaching Manual of CDS-Thieme, Thieme Clinical Companion Ultrasound)
(Images: Pecs University Department of Radiology, google images, ultrasoundcases.info)

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