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33 Cards in this Set

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A 38 year old male arrived in the ER with RUQ pain, fever, nausea, vomitting and subsequent weight loss. Labs showed an increase in WBCs. US appeared as a complex cyst with thick walls and debris, rounded but without smooth walls. Echogenic foci seen within the mass produced a dirty shadow
Pyogenic Hepatic Abscess
A 52 year old foreign gentleman came to the ER with a low-grade fever, RUQ tenderness, nausea, leukocytosis, and mild jaundice. Alkaline phsphatase was elevated. Adominal ultrasound showed a 2-layer cyst (cyst within a cyst) in the RLL. Smaller daughter cysts had developed in the inner layer. Patient stated that he was visiting the US from his home in the middle-east where he was a hard-working shepard
Hydatid Liver Cyst
(aka Echinoccocal Cyst)
A 45 year old female with a history of hypoglycemia was sent for an abdominal ultrasound. The sonogram showed hepatomegaly, increased echogenecity i nthe liver and an 8 cm adenoma. Her kidneys were also enlarged. She stated her mother had some sort of disorder that involved glucose, but she was unsure of specifics.
Von Gierke's Disease
(Type I Glycogen Storage Disease)
A body-builder with a history of a long-term steroid use was recently diagnosed with HIV. He states he has had a history of abnormal LFTs, but never followed up with an ultrasound since he was otherwise asymptomatic. The sonogram revealed what appeared to be necrosis of the liver parenchyma which was characterized by several cystic blood-filled cavities distributed randomly throughout the liver.
Peliosis Hepatis
A 65 year old male with known colorectal cancer complains of weight loss and back pain. Labs show an increase in ALT, Alpha-Fetoprotein and Alkaline Phosphatase. Ultrasound demonstrates multiple hypoechoic , vascular lesions of various sizes within the liver. Ascites is also present.
Hepatic Metastasis
A 32 year old female presents with a five day history of hemetemesis. She is a known diabetic. Her labs revealed abnormal liver function tests and hyperbillirubinemia. Sonographically, multiple cystic structures are seen in the area of the porta hepatis. A normal portal vein is not seen. The anechoic structures fill with color with Color Doppler interrogation and Doppler proves the vascularity with venous flow similar to portal venous flow
Cavernous Transformation
aka portal vein cavernoma
A 3 month old with a history of urinary problems is brought in for a renal ultrasound. A complex, heterogeneous, vascular mass is identified in the liver.
Infantile Hemangioendothelioma
MC benign vacular tumor of the liver in infancy and MC symptomatic liver tumor during the first 6 months of life
3rd MC liver tumor in children
A 33 year old male with jaundice and RUQ pain that worsens when lying on this right side. Returned from South American 6 months ago. Labs showed elevated Alkaline Phosphatase and normal AST levels. Ultrasound reveals multiple, round, hypoechoic nodules with smooth margins in the liver
Amebic Hepatic Abscess
Diff. Diag. - Hydatid cysts, Hepatic cysts, Hemangioma
Ranks 2nd worldwide among parasitic causes of death following malaria
A 32 year old pregnant female is seen by her doctor for complaints of abdominal pain, low grade fever, nausea, vomiting. Her blood work revealed high LFTs and leukocytosis. US examination showed isoechoic material within the portal vein and an increase in portal vein diameter
Portal Vein Thrombosis
A 28 year old female is seen in the ER with complaints of RUQ pain. When questioned about medications she informs the nurse she takes oral contraceptives. Her blood work reveals high LFTs. The US shows ascites, an enlarged liver with no visualization of hepatic veins
Budd Chiari Syndrome
A 44 year old male is seen by his doctor for RUQ pain. He tells his doctor he has just returned from a trip from South America. US reveals an occlusion of the portal vein with widened echogenic portal tracts. The liver and spleen appear enlarged. Ascites and varices are also present
MC parasitic infection in humans. caused by worms found in fresh water. Infection results when the worms puncture the skin and migrate to the portal vein or lymphatic system
A 38 year old AIDS patient is seen by his doctor for shortness of breath and tachycardia. His blood work reveals an elevation in alkaline phosphatase and gamme-glutamyl transpeptidase with normal transaminases. US shows an enlarged liver that has a mottled apperance
Pneumocystic Carinii (PCP)
Aka Pneumocystis Jiroveci pneumonia begins as a bacterial lung infection in immunocompromised patients and can spread to other organs such as the liver and spleen. PCP can also take on the Starry sky sign with multiple echogenic non shadowing foci
A 32 year old female came to the ER after an MVA, complains of abdominal tenderness. Labs show a decreased hematocrit. A CT and Ultrasound is ordered. The CT shows a large hyperattenuating mass in the right lobe of the liver. The US reveals an echogenic solid mass measuring 5 x 7 cm in the right lobe
Hepatic Hematoma
39 year old female comes in for routine MRI after a hysterectomy. MRi detects an isoechoic lesion in the right lobe of the liver with a central scar. US is ordered and reveals an isoechoic 4 x 3 cm lesion. Color doppler is used and shows a spokewheel pattern of flow within the lesion
Focal Nodular Hyperplasia (FNH)
2nd MC benign liver mass
50 year old male comes to ER with vague abdominal pain. US reveals a highly echogenic homogeneous solid mass in the left lobe of the liver measuring 3 x 3 cm
Hepatic Lipoma
36 year old female admitted to the hospital with RUQ pain. US is ordered to evaluate suspected cholelithiasis, which is confirmed and reveals a slightly lobulated hypoechoic lesion in the right lobe of the liver measuring 4 x 6 cm. LFTs show an AST of 56 U/L and alkaline phosphatase at 208 U/L and ALT of 64 U/L
Hepatic Epitheloid Hemangioendothelioma
A patient with a known history of alcoholism presents with jaundice, fatigue and weight loss. Lab results showed an increase in aspartate amniotransferase, alanine aminotransferase, and bilirubin. US findings show ascites surrounding a small liver with irregular borders. There was also evidence of portal hypertension and an enlarged spleen
A 52 year old male is referred for RUQ US for abnormal LFTs. The patient also reports that he has felt fatigue recently. The US shows ascites surrounding the liver. The portal vein was not identified due to the multiple varicosities at the porta hepatis. The sonographer also identified a patent umbilical vein in the left lobe of the liver
Portal hypertension
A follow up US is ordered for a patient with known cirrhosis. The patient had abnormal lab values. The US showed multiple cysts (the largest measuring 1.2 cm) near the biliary ducts. The cysts did not communicate with the ducts. A differential for this pathology is Caroli's disease
Peribiliary cysts
rare finding
A patient presents for a routine abdominal ultrasound. The patient is asymptomatic and has normal lab values. The US shows a liver with multiple, tiny, echogenic foci with ring down artifacts. This is a benign liver malformation
Biliary Hamartomas
aka Von Meyenburg Complexes
A 49 year old patient who is HIV positive came to the ER with a fever of 102 and complaining of RUQ pain. US revealed that his liver was enlarged and several small target lesions with a central echogenic region and peripheral hypoechoic halo were seen. This pattern could be described as a wheel within a wheel. His lab values were normal for a white blood cell count
Hepatic Candidiasis
aka fungal abscess
A 35 year old woman who had been taking oral contraceptives for five year came to her scheduled doctor's appointment complaining of slight right upper quadrant pain. Her doctor did an ultrasound and found several well circumscribed masses with an internal hemorrhage pattern. her lab values were normal. The doctor mentioned that these lesions have a variable appearance and a differential for this pathology is focal nodular hyperplasia
Hepatic Adenoma
aka liver cell carcinoma
An 80 year old woman had mild RUQ pain and an US was ordered. A hyperechoic mass with well defined margins was found in her posterior right liver. This is the MC benign hepatic tumor and is an arteriovenous malformation, so no biopsy was ordered. Normal labs
Cavernous Hemangioma
A 40 year old male came to the ER complaining of abdomen pain, weakness and weight loss. He also mentioned that he had been exposed to large doses of thorotrast in previous months. He appeared jaundiced and US revealed hepatomegaly, ascites, and several well differentiated lesions with cystic characteristics in his liver. The doctor had to break the bad news to him that he proably had less than two years left to live
aka Angiosarcoma
A 47 year old male was reffered by their physician for a RUQ US because of abnormal LFTs. Patient has a history of alcohol abuse and states they are asymptomatic. The liver is enlarged and echogenic, the vessel borders are not visualized. There is poor penetration through the liver to the right kidney and diaphragm
Fatty Liver
35 year old female, who recently received a blood transfusion, came to the ER with fever, N/V, RUQ pain, dark urine and fatigue. Incrased PT, AST, ALT and bilirubin. US reveals thickened portal veins and gb wall. Numerous non-shadowing foci throughout the liver (starry sky sign)
An US was ordered for a 32 year old feale who has a history of Non-Hodgkins lymphoma. Patient reports weight loss, fever, fatigue and night sweats. Abnormal LFTs. Sonographically, several target lesions of varying sizes were noted in the right and left lobes of the liver
18 month old male is admitted to the hospital for jaundice, vomitting, abdominal pain and swelling. Palpable abdominal mass and increased alpha fetoprotein levels. A single large heterogeneous mass with calcifications in the right lobe of the liver. Area around the mass is hyperechoic
MC malignant tumor of children under 5 years old
US of a 53 year old female complaining of RUQ pain. She has a history of obesity and diabetes. Her liver is enlarged and slightly echogenic. The right kidney was poorly visualized due to difficulty penetrating the liver
aka fatty liver
A 56 year old male, recovering alcoholic with documented cirrhosis was referred for an abdominal US. Complains of weight loss, fever and palp abdominal mass. US revealed ascites and a cirrhotic liver with a well defined hyperechoic lesion measuring 5 x 4 cm in the dome of the right lobe
MC primary form of liver cancer
26 year old female who complains of RUQ pain, nose bleeds, abnormal blood vessel formation on skin, fatigue shob, and jaundice. US revealed enlarged liver, dilated hepatic veins, a dilated hepatic artery along with hepatic AVMs. Additionally, hepatofugal flow in the portal vein and aneurysmal dilation of the portal vein was documented
Osler-Weber-Rendu Disease
aka hereditary hemorrhagic telangiectasia (HHT)
15 month old male with a history of bouts of vomitting and diarrhea, was seen for distended abdomen. US shows an enlarged liver with multiple hypoechoic lesions up to 9 mm present in both lobes. Both kidneys are enlarged and hyperechoic
aka hereditiary tyrosinemia
16 month old female was referred to the outpatient clinic for an abdominal US based on complaints of RUQ pain, respiratory distress, distended abdomen and fever. US shows hepatomegaly along with a large cystic lesion with septations located in the right lobe of the liver. The lesion was predominantly anechoic with a lace like configuration
Mesenchymal Hamartoma