Liver (IMAGES) Flashcards by Martina McDonald

Portal Vein
(INTRAsegmental)
Hepatopetal and Monophasic with some variation noted with respiration

How well did you know this?

Not at all

Perfectly

Normal Hepatopetal flow in the main portal vein

How well did you know this?

Not at all

Perfectly

Hepatic veins
Intersegmental and Hepatofugal with Triphasic low resistance flow
Increase in size towards the diaphragm

How well did you know this?

Not at all

Perfectly

Normal doppler signal from the right hepatic vein

How well did you know this?

Not at all

Perfectly

Normal doppler finding of the low resistance hepatic artery

How well did you know this?

Not at all

Perfectly

Common bile duct is seen being measured with the portal vein seen posterior

How well did you know this?

Not at all

Perfectly

Mickey Mouse Sign ( TRV PORTA HEPATIS)
Short arrow ; hepatic artery - left side
Long arrow : common bile duct - right side
Posteriorly seen in the portal vein

How well did you know this?

Not at all

Perfectly

This image shows the following ;
Right atrium and IVC (posterior margin) where the right hepatic vein branch is seen
The caudate lobe is seen with the ligamentum venosum

(Short arrow black ) : hepatic artery
Seen posteriorly is the portal vein

How well did you know this?

Not at all

Perfectly

Falciform Ligament

How well did you know this?

Not at all

Perfectly

Main lobar fissure can be seen between the left medial / lateral segments

How well did you know this?

Not at all

Perfectly

Sagittal oblique image of the liver demonstrating the right lobe
With additional view of the gallbladder, right kidney and main lobar tissue seen between the right portal vein and gallbladder

How well did you know this?

Not at all

Perfectly

Sagittal image of a diffusely fatty liver that demonstrates the inability to clearly visualize the diaphragm or vasculature

How well did you know this?

Not at all

Perfectly

Sagittal image of the liver demonstrating an area of focal fatty infiltration (arrows)

How well did you know this?

Not at all

Perfectly

Focal fatty sparing is noted in this sagittal image of the liver adjacent to the gallbladder

How well did you know this?

Not at all

Perfectly

Transverse image of the liver demonstrates the “starry sky” appearance frequently associated with hepatitis

How well did you know this?

Not at all

Perfectly

Ascites is noted surrounding this liver that is affected by cirrhosis.
Note the irregular, nodular contour of the liver.

How well did you know this?

Not at all

Perfectly

Enlargement of the caudate lobe compared to the left lobe is noted in this patient with cirrhosis

How well did you know this?

Not at all

Perfectly

A patent or recanalized paraumbilical vein is noted extended from the left lobe of this patient who is suffering from cirrhosis and portal hypertension.

How well did you know this?

Not at all

Perfectly

Recanalized paraumbilical vein is demonstrated extended from the left portal vein toward the anterior abdominal wall in a patient with portal hypertension.

How well did you know this?

Not at all

Perfectly

patient with portal hypertension, splenic varices are noted adjacent to the spleen in the area of the splenic hilum

How well did you know this?

Not at all

Perfectly

Enlarged coronary vein can be seen posterior to the left lobe in a patient with portal hypertension.

How well did you know this?

Not at all

Perfectly

Enlarged coronary vein (arrows) can be seen posterior to the left lobe in a patient with portal hypertension.

How well did you know this?

Not at all

Perfectly

Enlarged coronary vein (arrows) can be seen posterior to the left lobe in a patient with portal hypertension.

How well did you know this?

Not at all

Perfectly

Cavernous transformation of the portal vein. Transverse image through the porta hepatis demonstrates multiple, small collateral vessels in the area of the portal vein.

How well did you know this?

Not at all

Perfectly

Benign hepatic cyst. This liver mass has well-defined borders, is completely anechoic, has thin walls, and demonstrates posterior enhancement.

ADPKD cysts ( autosomal dominant polycystic kidney disease)

Hydatid disease. Transverse image of the liver demonstrates a complex mass containing a detached membrane, which is the typical appearance Water lily sign // mother/ daughter cyst

SONOGRAPHIC FINDINGS OF AN AMEBIC HEPATIC ABSCESS Round, hypochoic or anechoic mass or masses May contain debris (with fluid-debris layering) Acoustic enhancement

SONOGRAPHIC FINDINGS OF A PYOGENIC HEPATIC ABSCESs 1. Complex cyst with thick walls 2. Mass may contain debris, septations, and/or gas 3. The air within the abscess may produce dirty shadowing or ring-down artifact

SONOGRAPHIC FINDINGS OF HEPATIC CANDIDIASIS 1. Multiple masses with hyperechoic central portions and hypochoic borders (may be described as "target,» "halo," or "bull's-eye" lesions) 2. typically 1 cm or smaller in size 3. Older lesions may calcify

SONOGRAPHIC FINDINGS OF A CAVERNOUS HEMANGIOMA 1. Small, hyperechoic mass 2. Typically in the right lobe

SONOGRAPHIC FINDINGS OF FOCAL NODULAR HYPERPLASIA 1. Isoechoic, hyperechoic, or hypochoic mass 2. Central scar may appear as hyperechoic or hypochoic linear structure within the mass and will often reveal hypervascularity with color Doppler

SONOGRAPHIC FINDINGS OF A HEPATOCELLULAR ADENOMA 1. Mostly hypochoic 2. May be hyperechoic, isoechoic, or be comprised of mixed echogenicities

SONOGRAPHIC FINDINGS OF HEPATIC HEMATOMA 1. Fresh clot may appear hyperechoic 2. Older hemorrhage can appear anechoic or complex 3. May be intrahepatic or subcapsular

SONOGRAPHIC FINDINGS OF HEPATOCELLULAR CARCINOMA 1. Solitary, hypochoic mass 2. Heterogeneous masses scattered throughout the liver 3. Mass with a hypochoic halo and central echogenic portion ("target" or "bull's-eye" lesion) 4. Possible ascites

SONOGRAPHIC FINDINGS OF HEPATIC METASTASIS 1. Hyperechoic, hypochoic, calcified, cystic, or heterogeneous masses 2. Mass or masses demonstrating a hypochoic rim and central echogenic region 3. Diffusely heterogeneous liver 4. Possible ascites

The wall of the TIPS appears highly echogenic. transjugular intrahepatic portosystemic shunt. 90 -190 cm/sec

Normal TIPS flow

TIPS failure. occluded TIPS lacks color-flow filling, and echogenic material (clot) can be noted within the shunt.

Couinaud Segments : I. Caudatelobemayreceivebranchesofboththerightand left portal veins and may have one or more hepatic veins draining into the inferior vena cava II. Left lateral superior III. Left lateral inferior IV. Left medial superior (a) and inferior (b) V. Right anterior inferior VI. Right posterior inferior VII. Right posterior superior VIII. Right anterior superior

Ligamentum Venosum

Ligamentum venosum

Normal hepatic vein doppler signal

Fatty infiltration grades A; grade 1 B; grade 2 C; grade 3

Focal sparing secondary to fatty infiltration. condition should be suspected in patients who have masslike hypochoic areas in typical locations in a liver that is otherwise increased in echogenicity.

Hepatitis. The liver texture may appear normal or the portal vein borders are more echogenic than usual (known as the "starry sky" sign), the liver parenchyma is slightly more echogenic than normal, and attenuation may be present.

Chronic hepatitis. The liver parenchyma is coarse with decreased brightness of the portal triads; however, the degree of attenuation is not as great as is seen in fatty infiltration.

Diffuse liver disease Fatty infiltration secondary to cystic fibrosis

Diffuse liver disease Early stages of cirrhosis: hepatomegaly, decreased vasculature.

Cirrhotic liver with ascites.

Advanced cirrhosis with attenuation

Late-stage cirrhosis with shrunken liver and ascites

Late-stage cirrhosis with thick gallbladder wall, ascites, shrunken liver.

Normal hepatic artery doppler findings

The small adenoma presents as a well-demarcated, round, homogeneous, echogenic tumor With increasing size, the mass may become inhomogeneous

Hemochromatosis. Hepatomegaly with slightly increased echogenicity throughout the liver parenchyma

Portal hypertension. Transverse image of hepatosplenomegaly in a patient with advanced cirrhosis, decreased vasculature, and ascites. Thickened gallbladder wall, accentuated by the ascitic fluid.

Portal hypertension Hepatomegaly with massive ascites, and the portal vein is filled with thrombus. The sonographer should search for hepatofugal flow in the portal vein. Note the nodular border of the liver. The portal vein is dilated and completely filled with thrombus (arrows). Thrombosis of the main portal vein (arrows) with reduced flow.

Flow reversal within the portal vein

Portal vein thrombosis

TIPS - normal flow

Budd-Chiari syndrome. Transverse image of the enlarged liver and thrombosis of the inferior vena cava (IVC).

Obstruction proximal to the cystic duct may be secondary to pancreatic carcinoma or tumor invasion to the porta hepatis. Dilated intrahepatic ducts will result from this obstruction.

Obstruction distal to the cystic duct may be caused by stones in the common duct. The distal cystic duct is enlarged and obstructed by a stone at the distal end. The inferior vena cava is posterior to the duct.

Dilated common bile duct

Liver cyst appearing complex due to hemorrhage occurring

Peribiliary cysts seen as discrete, clustered tubular-appearing cysts with thin septa that parallel the bile ducts and portal veins in the central area of the liver.

Images of a liver parenchyma filled with multiple cystic lesions in patients with hepatic polycystic disease.

Pyogenic abscess is shown as a complex mass in the right lobe of the liver in a patient with cirrhosis, abdominal pain, and fever. The complex mass has round margins without increased through-transmission.

Amebic abscess is a complex lesion, usually in the right lobe of the liver. This patient recently returned from a vacation in Mexico and presented with right upper quadrant pain and fever for 2 weeks.

Echinococcal cyst. This complex mass found in the right lobe of the liver shows mixed fluid and debris components. ( hydatid)

Pneumocystis carinii. The sonographic pattern ranges from diffuse, tiny, nonshadowing echogenic foci to extensive replacement of the liver parenchyma by various echogenic clumps of calcification

Focal nodular hyperplasia is a subtle liver mass that may be difficult to differentiate in echogenicity from the liver parenchyma. The mass is usually isoechoic or nearly isoechoic compared with the liver parenchyma.

Hepatic adenoma. This lesion is usually hyperechoic with a central hypochoic area caused by hemorrhage.

Hepatocellular carcinoma: well-defined "bull's-eye" lesion. Hepatocellular carcinoma: well-defined isoechoic lesion.

Necrotic hepatoma: necrotic isoechoic lesion.

Advanced metastases: large isoechoic lesions.

Metastases: ill-defined complex necrotic lesion. Metastases: well-defined hyperechoic lesion.

Hepatocellular carcinoma shows a discrete hypochoic lesion in the right lobe of the liver. C and D, Transverse and sagittal images of the upper right quadrant show a large hepatocellular carcinoma in the right lobe of the liver. E and F, Hepatocellular carcinoma in a 58-year-old male shows hepatomegaly with diffuse abnormal lesions throughout the liver parenchyma.

Lymphoma was found in this elderly male with hepatomegaly. Multiple isoechoic lesions were found throughout the liver.

Liver (IMAGES) Flashcards

(83 cards)