ULTRASOUND LIVER CYSTIC MASSES PPT PRESENTATION

ABDOMINAL ULTRASOUND NOTES
TOPIC 11: CYSTIC MASSES
Explore all liver cystic masses in this powerpoint presentation.

1. by OKSANA H. BALTAROWICH, M.D.
Jefferson Ultrasound Research & Education Institute
We gratefully acknowledge support of this project by the Open Society Institute-New York
SONOGRAPHY
OF
CYSTIC LIVER
MASSES

2. CYSTIC LIVER MASSES
•Benign
•Malignant

3. BENIGN CYSTIC LIVER LESIONS
•Cyst
•Hematoma
•Abscess
•Biloma / seroma
•Biliary cystadenoma
•Vascular
– aneurysm
– fistula (a-pv, p-hv)

4. CONGENITAL HEPATIC CYSTS
•Most common liver lesion
•2 - 5% population
•Simple cyst criteria
–anechoic
–smooth, thin walls
–well-defined sharp back-wall
–acoustic enhancement
•Partial septations common
•Lobulated border common

7. HEPATIC CYSTS
•Primary cysts are congenital
–uncommon
•Secondary cysts are acquired
–trauma (biloma, seroma,
hematoma)
–infection (pyogenic, parasitic)

8. HEPATIC CYST COMPLICATIONS
•Hemorrhage
•Infection
•Recurrence

11. MULTIPLE HEPATIC CYSTS
Autosomal Dominant Polycystic Kidney Disease
Von Hippel-Lindau Syndrome

12. K
L

13. LIVER HEMATOMA
•Spontaneous
•Post-traumatic
•Post-biopsy

18. LIVER ABSCESS
•Collection of pus in the liver
•Origin
–Pyogenic origin
–Non-pyogenic
•Amebiasis
•Echinococcal disease (hydatid)
•Fungal
•Schistosomiasis

20. PYOGENIC ABSCESS
•Usually E. coli, anaerobes
•Complex fluid-filled collections
–thick-wall
–fluid-fluid level
•Echogenic masses
•Increased sound transmission
•Gas: shadowing or ring-down
•May calcify

22. ECHINOCOCCAL CYST
•Cystic, complex, echogenic “solid”
•Laminated membrane
–“double line” sign
–“floating lily pad” sign
•Final stage: calcified
•Complication: rupture
–biliary tree, pleura, peritoneum

30. AMEBIC ABSCESSES
•Entamoeba histolytica
•Transmission: oral-fecal route
•Sonographic features
–round or oval shape
–homogeneous low-level internal echoes
–thin appearing wall
–posterior enhancement
–mostly right lobe

33. BILIARY CYSTADENOMA
•Middle-aged females
•Size 1.5 - 30cm
•Most larger than 10cm
•Painful epigastric mass
•Intermittent jaundice

35. MALIGNANT CYSTIC LIVER
LESIONS
•Cystic metastases
•Biliary cystadenocarcinoma

36. CYSTIC LIVER METASTASES
•Cystic primary carcinoma
– Ovarian
– Colon
•Necrosis, large size
– Sarcoma (esp. Leiomyosarcoma)
– Squamous cell
– Testicular (embryonal cell)
– Melanoma

38. BILIARY CYSTADENOCARCINOMA
•Multiseptated cystic mass
•Solid papillary projections
SONOGRAPHIC APPEARANCE