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Fatty Infiltration
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Fatty infiltration: is an increased lipid accumulation that may be a systemic disorder leading to the impaired or excessive metabolism of fat. It is usually a benign, reversible process.
Sonographic Appearance: increased echogenicity, impaired visualization of borders, hepatomegaly; may be patchy.
Images obtained by: Medison
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Acute Hepatitis
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Acute Hepatitis: is an inflammation of the liver and is difficult to diagnose with ultrasound. It is caused by one of several hepatotropic viruses, known as Hepatitis A, B, C, and E. It is the most prevalent liver disease in the world and most common cause of jaundice clinically. Chronic hepatitis may lead to cirrhosis and liver failure.
Sonographic Appearance: Acute can appear normal or slightly more echogenic than normal, attenuation may be present. The portal vein and borders are more prominent than usual.
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Chronic Hepatitis
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Chronic Hepatitis: exists when there is clinical or biochemical evidence of hepatic inflammation for at least three to six months.
Sonographic Appearance: The liver parenchyma is coarse with decreased brightness of the portal triads, but the degree of the attenuation is not as great as it is seen in fatty infiltration. Fibrosis may be evident, which may produce soft shadowing posteriorly.
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Cirrhosis
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Cirrhosis: is a chronic degenerative liver disease characterized by loss of normal liver function and structure. It is the consequence of prolonged and severe insult to the liver cells resulting in hepatocellular death. The disease is irreversible and can lead to liver failure, portal hypertension, hepatocellular carcinoma and death.
Sonographic Appearance: coarsening of the liver parenchyma secondary to fibrosis and nodularity. Increased attenuation may be present, with decreased vascular markings. Hepatosplenomegaly may be present with ascites surrounding the liver. Chronic cirrhosis of the liver edge. The isoechoic regenerating nodules may be seen throughout the liver parenchyma. Portal hypertension may be present with or without abnormal Doppler flow patterns. Patients have an increased incidence of hepatoma tumors within the liver.
Images obtained by: Medison.com
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Glycogen Storage Disease
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Glycogen Storage Disease: (von Gierke’s disease) occurs when abnormally large and amounts of glycogen are deposited in the liver and kidneys.
Sonographic Appearance: hepatomegaly, increased echogenicity, and increased attenuation. The adenomas present as round, homogenous, echogenic tumors.
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Biliary Obstruction Proximal
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Biliary obstruction: (Proximal) to the cystic duct can be caused by carcinoma of the common bile duct or metastatic tumor invasion of the porta hepatic.
Sonographic Appearance: Carcinoma of the common bile duct shows as a tubular branching with dilated intrahepatic ducts best seen in the periphery of the liver. It may be difficult to image a discrete mass lesion. The gallbladder is of normal size, even after a fatty meal is administered.
Images obtained by: Copyright protected material used with permission of the authors and the University of Iowa's Virtual Hospital, www.vh.org."
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Biliary Obstruction Distal
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Biliary Obstruction:(Distal) to the cystic duct may be caused by stones in the common bile duct, an extrahepatic mass in the porta hepatitis, or stricture of the common bile duct.
Sonographic Appearance: The dilated intrahepatic ducts are seen in the periphery of the liver. The gallbladder size is variable, usually small. Gallstones are present and appear as hyperechoic lesions along the posterior floor of the gallbladder with a sharp posterior acoustic shadow.
Images obtained by: Medison
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Extrahepatic Mass
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Extrahepatic Mass: in the area of the porta hepatitis causes the same clinical signs as seen in biliary obstruction.
Sonographic Appearance: An irregular, ill-defined, hypoechoic and inhomogenous mass lesion may be seen in the area of the porta hepatitis. There is intrahepatic ductal dilation, with a hydropic gallbladder.
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Common Duct Stricture
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Common Duct Stricture: Clinically the patient with common duct stricture is jaundiced and has had a previous cholecystectomy.
Sonographic Appearance: A common duct stricture presents as dilated intrahepatic ducts with absence of a mass in the porta hepatic.
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Passive Hepatic Congestion
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Passive Hepatic Congestion: develops secondary to congestive heart failure with signs of hepatomegaly.
Sonographic Appearance: Dilation of the IVC, SMV, hepatic, portal, and splenic veins noted. The venous
structure may decrease in size with expiration and increase with inspiration.
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Focal Hepatic Disease
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Focal Hepatic Disease: very few hepatic lesions have specific sonographic features. Therefore it is important to medications clinical history in the sonographic pattern associated with various lesions.
Sonographic Appearance: A sonographer should be able to differentiate whether the mass is extrahepatic or intrahepatic. Intrahepatic masses can displace the hepatic vasculature, cause external bulging of the liver capsule, or a posterior shift of the IVC. Extrahepatic masses may show internal invagination of the liver capsule, formation of a triangular fat wedge, anteromedial shift of the IVC, or anterior displacement of the right kidney.
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Simple Hepatic Cysts
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Simple Hepatic Cysts: hepatic cyst may be congenital or acquired, solitary or multiple. Patients are often asymptomatic unless the cyst is large enough to compress the hepatic vasculature or ductal system.
Sonographic Appearance: anechoic, round, well-defined borders, good through transmission, and posterior enhancement.
Images obtained by: Medison
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Congenital Hepatic Cysts
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Congenital Hepatic Cysts: a solitary congenital cyst of the liver is rare and usually an incidental lesion. It arises from developmental defects in the formation of bile ducts.
Sonographic Appearance: the mass is solitary and may vary in size. The cyst is usually found on the inferior undersurface of the liver.
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Polycystic Liver Disease
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Polycystic Liver Disease: is autosomal dominant, multiple cystic lesions fill up the parenchyma. 50% of the patients will also have polycystic renal disease.
Sonographic Appearance: on ultrasound to be cysts generally present as anechoic, well-defined borders with acoustic enhancement.
Images obtained by: Medison
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Pyogenic Abscess
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Pyogenic Abscess: is a pus forming abscess.
Sonographic Appearance: The ultrasound appearance of a pyogenic abscess may be variable depending on the and internal consistency of the mass. It can range in size from 1 cm to very large. The right central lobe of the liver is the most common sight for abscess development. The abscess may be hypoechoic with round or ovoid margins and increased acoustic enhancement, or it may be complex with irregular walls. It may have a fluid level; if gases are present, it can be hyperechoic with dirty shadowing.
Images obtained by: mitene.or.jp
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Hepatic Candidiasis
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Hepatic Candidiasis: is caused by a species of Candida. It usually occurs in immunocompromised hosts. The candidal fungus invades the bloodstream and may affect any organ.
Sonographic Appearance: Candida is within the liver may present as multiple small hypoechoic masses with echogenic central cores, referred to as bull's-eye or target lesions.
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Chronic Granulomatous Disease
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Chronic granulomatous disease: is a recessive trait related to congenital defect in the leukocyte that renders it unable to an activate catalase-positive, previously phagocytized bacteria.
Sonographic Appearance: A poorly marginated, hypoechoic mass is seen with posterior enhancement. Calcifications may be present with posterior shadowing.
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Amebic Abscess
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Amebic Abscess: is a collection of plus formed by disintegrated tissue in a cavity, usually in the liver, caused by the protozoan parasite Entamoeba histolytica.
Sonographic Appearance: The ultrasound appearance is variable and nonspecific. The abscess may be round or oval and lack significant defined wall echoes. The lesion is hypoechoic compared with normal liver parenchyma, with low level echoes at higher sensitivity. It may have debris and distal enhancement.
Images obtained by: www.medicine.cmu.ac
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Echinococcal Cyst
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Echinococcal Cyst: is an infectious cystic disease common in sheep-herding areas of the world. It is a tapeworm that infects humans.
Sonographic Appearance: several patterns may occur, from a simple cysts to a complex mass with acoustic enhancement. The shape may be oval or spherical, with regularity of the walls. Calcifications may occur. Calcifications are frequent and include honeycomb appearance with fluid collections; “water lily” sign, which shows a detachment and collapse of the germinal layer; or “cyst within a cyst.”
Images obtained by: www.zim.org
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Cavernous Hemangioma
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Cavernous Hemangioma: a hemangioma is benign, congenital tumor consisting of large, blood filled cystic spaces. The hemangioma is the most common benign tumor of the liver.
Sonographic Appearance: the ultrasound appearance is typical; most are hyperechoic with acoustic enhancement. They are round, oval, or lobulated with well-defined borders. Hemangiomas may become more heterogenous as they undergo degeneration and fibrous replacement.
Images obtained by: Medison
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Liver Cell Adenoma
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Liver Cell Adenoma: a tumor of the glandular epithelium in which the cells of the tumor are arranged in a recognizable glandular structure.
Sonographic Appearance: the mass can look similar to focal nodular hyperplasia. It is hyperechoic with the central hypoechoic area caused by hemorrhage. The lesion may be solitary or multiple.
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Focal Nodular Hyperplasia
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Focal Nodular Hyperplasia: the lesion is composed of normal hepatocytes, Kupffer cells, bile duct elements, and fibrous connective tissue.
Sonographic Appearance: The lesions appear well-defined with hyperechoic to isoechoic patterns compared with the liver.
Images obtained by: Medi.ru/doc
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Hepatocellular Carcinoma
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Hepatocellular Carcinoma: the pathogenesis of hepatocellular carcinoma is related to cirrhosis. The carcinoma may present as a solitary massive tumor, multiple nodules throughout the liver, or diffuse infiltrative masses in the liver. All of these patterns cost hepatomegaly.
Sonographic Appearance: a veritable appearance is noted with discrete lesions, either solitary or multiple, better usually hypoechoic or hyperechoic. Sometimes the lesions may be isoechoic, and a halo may surround the lesion. Another pattern present as diffuse parenchymal involvement, heterogenous throughout the liver without distinct masses. The last pattern is a combination of discrete and diffuse echoes.
Images obtained by: GE
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Metastatic Disease
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Metastatic Disease: is the most common form of neoplastic involvement of the liver. It is cancer that originated in another organ and has spread to the liver.
Sonographic Appearance: Can present as a well-defined hypoechoic mass, a well-defined echogenic mass, or diffuse distortion of the normal homogenous parenchymal pattern without a focal mass.
Images obtained by: Philips
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Lymphoma
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Lymphoma: patients with lymphoma have hepatomegaly with a normal or diffuse alteration of parenchymal echoes. A focal hypoechoic mass is sometimes seen.
Sonographic Appearance: Hodgkin's lymphoma presents with hypoechoic and diffuse ultrasound patterns in the liver. Non-Hodgkin's lymphoma may appear with target and echogenic mass lesions.
Images obtained by: GE
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Hepatic Trauma
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Hepatic trauma: or laceration occurs in 3% of trauma patients and is frequently associated with other injured organs. The need for surgery is determined by the size of
the laceration, the amount of hemoperitoneum, and the patient’s clinical status. The right lobe is affected more often then the left. The degree of trauma can vary.
Sonographic Appearance: Ultrasound does not clearly distinguish small lacerations in the dome of the right lobe of the liver. Intraperitoneal fluid should be assessed along the flanks and into the pelvis. Intrahepatic hematomas are hyperechoic in the first 24 hours and hypoechoic and sonolucent thereafter because of the resolution of the blood within the area. Septations
and internal echoes develop 1 to 4 weeks after the trauma. A subscapsular hematoma may appear as anechoic, hypoechoic, septated lenticular, or curvilinear.
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Liver Transplant
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Liver Transplant: transplantation of the liver or a portion of the liver.
Sonographic Appearance: The primary function of the ultrasound examination is to evaluate the portal venous
system, the hepatic artery, the IVC, and the liver parenchymal pattern. The vascular structures should assessed for size and patency in the pre-operative evaluation. The liver parenchyma should be examined to rule out the presence of hepatic architecture disruption. The sonographer should also evaluate the biliary system, to look for dilation, and the portosystemic collateral vessels. In the post operative period, hepatic artery thrombosis is the most serious complication of liver transplantation. The hepatic artery is evaluated with Doppler and color flow ultrasound in the area of the porta hepatis. The normal hepatic artery flow produces a low-resistance arterial signal. Thrombosis may be detected when the signal is absent.
Images obtained by: GE
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Portal Venous Hypertension
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Portal venous hypertension: is a development of increased pressure in the portal-splenic venous system. The hypertension develops when hepatopedal flow is impeded by
thrombus or tumor invasion. Ultrasound may be very useful in these patients to define
the presence of ascites, hepatosplenomegaly, and collateral circulation.
Sonographic Appearance: Portal flow is absent and the vessel may be filled with hypoechoic thrombus. The blood might reverse its flow and go back towards the spleen. The umbilical vein may become recanalized secondary to portal hypertension. Collateral vessels may develop.
Images obtained by: GE
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Budd-Chari Syndrome
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Budd-Chari syndrome: is an uncommon, often dramatic illness caused by thrombosis of the hepatic veins or IVC.
Sonographic Appearance: The caudate lobe becomes enlarged and there is often atrophy of the right hepatic lobe. The liver appears hypoechoic and inhomogenous, with fibrosis in later stages. Doppler may show altered blood-flow patterns in the hepatic veins and IVC.
Images obtained by: GE
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Ascites
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Ascites: Is the presence of excess fluid in the peritoneal cavity.
Sonographic Appearance: Anechoic pockets of fluid. Non encapsulated.
Image provided by: GE
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Hepatoma
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Hepatoma: A primary malignant tumor of the liver.
Sonographic Appearance: Intrahepatic hepatomas are hyperechoic in the first 24 hours and hypoechoic and sonolucent thereafter. Septations and internal echoes may develop.
Image provided by: Medison
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Pleural Fluid
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Pleural Fluid: Free fluid in the pleural cavity.
Sonographic Appearance: Anechoic to hypoechoic depending on contents.
Image provided by: www.aloka.at
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