Stase usg nodul meta ika lovnur zul ita 7 okt.pptx

nodul metastase hepar

1. Stase usg Supervisor: dr. Agung Setyawan , Sp. Rad (K) dr. Liana Karliasari , Sp. Rad (K) Resident Incharge : Ika – Lov- Nur – Zul - Ita

2. Identitas dan Riwayat Pasien mengeluh sesak hilang timbul terutama saat aktivitas , batuk (+) dahak sulit keluar , BB turun 12 kg dalam 3 bulan , nyeri dada (+). Pasien telah terdiagnosa lung tumor kanan berdasarkan CT scan thorax dari RS luar , saat ini keluhan sesak , nafsu makan menurun , mual (+) dan muntah (-).

3. RLL N

4. CX

5. 7

6. Kesimpulan Nodul multiple hepar ec. proses metastasis

7. Terima kasih 9

8. teori

9. LIVER LESIONS HYPERECHOIC HYPOECHOIC BENIGN MALIGNA MALIGNA BENIGN

10. HCC Typically a small focal HCC appears hypoechoic compared with normal liver. Larger lesion are heterogenous due to fibrosis, fatty changes, necrosis and calcification. A peripheral halo of hypoechogenicity may be seen with focal fatty sparing Hepatic Metastase Rounded and well defined Positive mass effect with distortion of adjacent vessels Hypoechoic: most common ~65% and is concerning feature Hypoechoic halo due to a compressed and fat spared liver Lesi hipoechoic : Malignant

11. *A few septa may be possible, but no wall thickening *A small amount of layering debris is possible *No internal vascularity on colour doppler

12. Hiperechoic lesion : Malignant

13. Hyperechoic lesion : benign

14. Hepatic metastases Hepatic metastases  are 18-40 times more common than  primary liver tumors   The most common sites of primary malignancy that metastasize to the liver are : Gastrointestinal tract (via portal circulation) colorectal carcinoma pancreatic ductal adenocarcinoma esophageal cancer gastric carcinoma gastrointestinal stromal tumor neuroendocrine tumors Breast cancer Lung cancer G enitourinary system ovarian cancer endometrial cancer renal cell carcinoma ureteral and bladder cancer Melanoma uveal melanoma Sarcomas Adrenocortical carcinomas E ssentially all metastatic solid malignancies Testicular cancer

15. Differentiating Primary and Metastases Usually multiple, but may be rarely single. Multiple, solid echogenic nodules with surrounding hypoechoic halo of varying sizes, giving target sign or bull’s eye sign are suggestive of metastases

16. Hyperechoic metastases Hypoechoic metastases Calcific metastases Cystic metastases Diffuse infiltrative metastases Adenocarcinoma of colon Gastrointestinal tumors Renal cell carcinomas Carcinoid tumors Choriocarcinoma Islet cell tumor Breast carcinoma Lung carcinoma May be from gastric, esophageal, and pancreatic cancers Mucinous adenocarcinomas ( colon ) Cystadenocarcinoma of ovary and pancreas Mucinous carcinoma of colon Necrotic colorectal metastases Neuroendocrine tumors Often confused with chronic liver disease Seen in breast and lung cancer; malignant melanoma

17. T arget or Bull's eye lesion/sign Hypoechoic halo sign (also known as  target  or  bull's eye sign ) in  liver metastases : used in hepatobiliary imaging, is a concerning feature for malignant lesion if the lesion is a  hyperechoic liver lesion Bull’s-eye or “target” metastatic lesions - Alternating layers of hyper- and hypoechoic tissue Solid mass with hypoechoic rim or halo Usually from aggressive primary tumors

18. Terima Kasih 27