Malignant focal liver lesions

Metastasis • Liver is a most common site of metastatic disease

Metastasis

Clinical presentation-:• Jundice •Rt sided pain•Hepatomegally •Increase abdominal girth from ascites•Altered liver function tests

Metastasis Ultrasound appearance-:

• If very small can be missed • Solid focal lesion with ill defined margin • May be hypoechoic , hyperechoic , isoechoic or mixed pattern• Mass effect on adjacent structures• Calcifications may be seen• Other features as lobulated outline of the liver , hepatomegally , ascites and lymphadenopathy ( para-aortic , para-caval and portal region ).

Metastasis

MetastasisBull’s eye appearance

MetastasisNotes-:

When searching for liver metastasis , a full scan of the whole abdomen is necessary.

Lymphadenopathy may be difficult to demonstrate on ultrasound

Hepatocellular carcinoma Predisposing factors • Hepatitis• Cirrhosis • Drug related liver diseases

Hepatocellular carcinoma Clinical presentation :-Small tumors are asymptomatic but causes a raised alpha-fetoprotein

Hepatocellular carcinomaUltrasound appearance-:

• Small lesion in cirrhotic liver can be missed •HCC may be hypoechoic , hyperechoic or mixed echopattern •May be solitary or multiple

Hepatocellular carcinoma

Hepatocellular carcinoma

Diffuse liver diseases

Diffuse fatty infiltration of the liverCaused by accumulation of fat within the hepatic cells

Predisposing factors-: Alcoholism Obesity Diabetes

Diffuse fatty infiltration of the liverUltrasound appearance-:

The liver appears hyperechoic As the level of fat deposition increases , the level of echogenicity may reach that of the highly reflective portal tract walls.

The liver appears smooth and homogenous ( ground glass appearance )The contrast between the liver and RT kidney is increased

Diffuse fatty infiltration of the liver

• Intrahepatic vessel borders cannot be visualized• Nonvisualization of diaphragm in sever cases

Diffuse fatty infiltration of the liver

Diffuse fatty infiltration of the liver

Notes-:

• Fatty infilteration itself is not usually a significant findings .• Infilteration often occurs in conjunction with other diffuse processes as cirrhosis .• Its increased attenuation reduces the ability of ultrsound to exclude other disease or focal lesions .

Cirrhosis Cirrhosis is defined as hepatic fibrosis with the formation of nodules

Bands of fibrous tissue are laid down in the liver parenchyma between the hepatic lobules leading to distortion of and destruction the normal architecture of the liver separating it into nodules .

Cirrhosis

Cirrhosis is not a disease itself but it is a process associated with end stage chronic liver disease

It can result from chronic hepatitis , alcoholic disease Congenital form :- glycogen storage disease , haemochromatosis and wilson’s disease.

CirrhosisClinical picture-:

Pruritis FatigueJaundice SteatorrheaRaised alkaline phosphatase and serum bilirubinSigns of portal hypertension

CirrhosisUltrasound pictureat first hepatomegally then average size then shrunken

increased echogenicity, coarse, heterogenous

Nodular surfaceRegenerating nodules: hypoechoicUnequal distribution of cirrhosis in different segments

Cirrhosis

Portal hypertension* Collaterals: left gastric, paraesophageal, gastric , porta hepatis, splenorenal and gall bladder wall* Splenomegaly Ascites

CirrhosisComplications

Hepatocellular carcinoma (HCC) occurs in 10% of patients with cirrhosis;

Esophageal varices with bleeding

Cirrhosis

Cirrhosis

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