Liver lesion by dr muhammad qasim khan

Liver lesions on ultrasonography

1. Liver lesions on USG Dr Muhammad Qasim Khan Resident Radiology

2. BEIGN TUMORS

3. MALIGNANT TUMORS

4. DIFFUSE PARENCHYMAL DISEASE

5. CYSTS Most common focal liver lesion Cysts Display three classic sonographic criteria an anechoic lumen, increased through transmission A well-defined back wall Cysts are referred to as complex if they have internal echoes, a thick wall, septations that are numerous or thick, solid elements, or calcification.

6. Complex cystic lesions are most often due to hemorrhage . Other causes are superinfected cyst, hematomas, abscesses, bilomas , cystic metastases, hemorrhagic or necrotic tumors

7. H ow to differ b/w cyst and aneurysms ?? Vascular lesions such as aneurysms, arterioportal fistulas, and portal hepatic vein fistulas can simulate cysts.

8. BENIGN TUMORS--- HEMANGIOMA most common benign liver neoplasm more often in women The typical appearance is a homogeneous , hyperechoic mass that is usually less than 3 cm in size margins are usually sharp and smooth

9. Benign Tumors… FOCAL NODULAR HYPERPLASIA Tumor of the liver that is composed of Kupffer cells, hepatocytes , and biliary structures but lacks the typical normal lobular hepatic features of portal triads and central veins. Uncommon, it is the second most frequently encountered benign liver tumor More common in women (80% to 90%)

10. they are not related to birth control pills, although birth control pills may promote their growth On Ultrasound The echogenicity of both FNH and its scar is variable, and it may be difficult to detect on ultrasound.  Some lesions are well marginated others are isoechoic with surrounding liver.  Detectable lesions characteristically will demonstrate a central scar with the displacement of peripheral vasculature on color Doppler examination. However , these findings are seen in only 20% of cases  .  

11. Benign Tumors--- Hepatic adenoma Generally hormone-induced usually solitary female predominance related to the use of oral contraceptives obesity and metabolic syndrome are emerging risk factors On Ultrasound usually presents as a solitary , well-demarcated , heterogeneous mass .  A hypoechoic halo of   focal fatty sparing  is also frequently seen.

12. BENIGN LESIONS--- BILIARY HAMARTOMAS Rare benign lesions consisting of abundant fibrocollagenous tissue containing disorganized bile ducts. They are typically less than 5 mm in size and scattered diffusely throughout the liver. ON ULTRASOUND Usually solid, nonshadowing , homogeneous, and either hyperechoic

13. MALIGNANT TUMORS--- METASTASES The lungs and liver are the most frequent sites of distant metastatic disease, Up to 50% of patients dying of cancer have liver metastases They have a target appearance with an echogenic or isoechoic center and a hypoechoic halo

14. Malignant lesion--- Hepatocellular Carcinoma fifth most common malignancy worldwide, and the third most common cause of cancer-related death 90% of HCC occurs in cirrhotic livers Chronic hepatitis C and B, alcohol One pattern that is typical of HCC is a large dominant lesion with scattered smaller satellite lesions

15. T endency to invade the hepatic vasculature USG is widely used in screening sensitivity of approximately 95%

16. Metastatic Tumors--- Lymphoma On sonography , it usually simulates metastatic disease, typically appearing as target lesions or as homogeneous hypoechoic masses Unlike metastatic disease, it is very unusual for lymphoma to appear hyperechoic , to contain cystic spaces, or to contain calcification. Because lymphoma is a very homo - geneous tumor

17. Lymphoma

18. Infection--- Pyogenic Abscess Most often a secondary development of seeding from intestinal sources Hepatic abscesses typically appear as complex fluid collections with a mixed echogenicity , as thick-walled cystic lesions or as cysts with fluid–fluid levels may mimic solid hepatic masses. The presence of through transmission will often provide a clue to the liquefied nature of the mass

19. DIFFUSE PARENCHYMAL DISEASE Usually results in no detectable sonographic abnormality . In a limited number of patients it can cause increased echogenicity of the portal triads, which appear as small bright areas on views of the liver periphery

20. Diffuse parenchymal disease--- Cirrhosis Caused by hepatocellular death and resulting fibrosis and regeneration. It occurs most commonly due to alcohol abuse, which causes micronodular changes (<1 cm ) Hepatitis is the most common cause and results in macronodular cirrhosis ( 1 -5 cm )

21. nodularity is a sonographic sign of cirrhosis Coarsening and nodularity of the liver parenchyma are other useful signs of cirrhosis Nodularity and coarsening of the liver become severe, it can be difficult to detect focal masses. In such cases MRI should be considered