Us_General_Liver Malign, Portal Hypertension

Front 1

Peliosis hepatis

Back 1

- rare, benign
- cavities from 1 mm -cm wit blood
- rupture of reticulin fibers that support sinusoid wall
- do not displace (push away) portal tracs
- distinguish from hemangioma by presence of portal tracts inside blood spaces

Front 2

Benign liver tumors

Back 2

cavernous hemangioma
liver cell adenoma
hepatic cystadenoma
focal nodular hyperplasia
fatty tumors

Front 3

Malignant disease

Back 3

hepatocellular carcinoma
metastatic disease
lymphoma

Front 4

Cavernous hemangioma

Back 4

-most common benign liver tumor
-multiple vascular chanels lined by a single layer of endothelium with fibrous septa
-hyperechoic with enhancement
-round, oval, well defined
-may show necrosis, degeneration, calcification

Front 5

Hemangioma

Back 5

-small, less than 3cm
-well defined, homogenous, hyperechoic mass
-posterior enhancement corelated with hypervascularity
-nonhomogenic central area
-echogenic border
-tend to grow very slow
-found in the subcapsular hepatic parenchyma
-more freq. in the posterior R lobe

Front 6

Liver cell adenoma

Back 6

- more common in woman
- more often with von Gierke's disease
- linked to birth contol pills
- normal to slight atypical hepatocytes, with area of bile stasis, focal hemorrhage or necrosis
- big risk of hemorrage, should be removed

Front 7

Focal nodular hyperplasia
FNH

Back 7

-second most common benign mass, woman less 40 years
-developmental related to an area with vascular malformation
-solitary mass with a scar, less than 5 cm
-well defined with a hypo or iso center, may have internal linear echoes
-freq. in R lobe of liver

Front 8

Hepatic Cystadenomas

Back 8

- contain cysts within the lesion
- rare, middle aged woman
- palpable abdominal mass

Front 9

Fatty tumors

Back 9

- extremly rare
- association with renal angiomyolipoma and tuberous sclerosis
- assymptomatic

Front 10

Malignant neoplasm

Back 10

-HCC (hepatocelular carcinoma) most common
-more prevalent in men
-Hep B and Aflatoxin (toxin produced by mold) predisp. factors
-cirrhosis 80% may become HCC

Front 11

Hepatocellular carcinoma
HCC
Symptoms

Back 11

- palpable mass
- hepatomegaly
- apetit disorder
- fever

Front 12

Hepatocellular carcinoma
HCC

Back 12

- can have 3 patterns
- solitary massive tumor
- multiple nodules through lver
- diffuse infiltrative masses
- solitary and multiple nodules may have a halo
- can not be differenciated on US from metastases

Front 13

Fibrolamellar carcinoma

Back 13

- subtype of HCC in young px (adolescents and young adults)
- without preexisting liver disease
- better prognosis than HCC
- can have internal punctate calcification and central echogenic scar

Front 14

Metastatic disease

Back 14

- most common form of neoplastic involvement of liver
- primary sites of cx; colon, breast, lung
- typicaly both lobes involved
- solitary or multiple
-well defined or diffuse
- hypoechoic mass are also hypovascular (necrotic or ischemic area)
- hyperechoic mass are hypervascular
- echogenic mass - primary colon cx
- target (bullseye) result from edema around tumor (necrosis, hemorrhage in the tumor), more common from lung cancer

Front 15

Lymphoma

Back 15

- diffuse mass - Hodgkins
- target hypoechoic mass - non Hodgkins
- multiple small, solid masses - leukemia

Front 16

Hepatic trauma

Back 16

- liver 3rd organ injured
- R lobe more afected than L one
- should evaluate for intraperitoneal fluid (flanks and pelvis)
- intrahepatic hematoma are hypoechoic first 24 H
- 1-4 w. post trauma, septations and internal echoes develop

Front 17

Liver transplant

Back 17

- most common in adult cirrhosis (secondary to active hep), Budd-Chiari sindr, hepatomas
- most common post operative - hepatic artery thrombosis

Front 18

Portal vein flow

Back 18

- low velocity
- lower scale
- continuous with respiratory changes

Front 19

Hepatic artery flow

Back 19

- low resistant flow
- systolic upstroke
- continuous flow
- if liver failure, touch the base line or even negative values

Front 20

Hepatic veins flow

Back 20

- triphasic
- when RA contracts, we do not see blood flowing, but a small reverse, on screen negative values