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Focal Liver Lesions - Chaper 13.2 Media Library
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Fig 13.2.1 Liver cyst Liver cysts are characteristically round, anechoic (1), smoothly delineated FLL with hyperechoic anterior (2) and posterior (3) wall, refraction shadows at their edges (4), a strong posterior wall echo (4) and post-cystic enhancement (5) resulting from an intensity difference between the beam intensity deep to the cysts and in the cysts. Transverse view of the pancreas - normal echogenicity. The left liver lobe was used as the acoustic window.
Fig 13.2.2 Hydatid cyst Hydatid cyst, stage 3, cyst in the cyst pattern.
Fig 13.2.3 Calcification Calcification is shown with shadowing. Next to the calcification an isoechoic hemangioma is shown with posterior acoustic enhancement
Fig 13.2.4a Hemangioma - typical hyperechoic aspect
Fig 13.2.4b Hemangioma - atypical aspect: lobulated and hypoechoic hemangioma in a fatty liver.
Fig 13.2.5a Focal nodular hyperplasia (FNH) - Isoechoic FLL with typical Doppler feature – spoke - wheel appearance (histology proven FNH)
Fig 13.2.5b Focal nodular hyperplasia (FNH) - hypoechoic aspect in bright fatty liver parenchyma (histology proven FNH)
Fig 13.2.6a Hepatocellular adenoma (HCA). HCA are typically isoechoic and difficult to detect if small (histology proven HCA).
Fig 13.2.6b Hepatocellular adenoma (HCA). In patients with liver storage diseases (e.g. glycogenosis) adenomas are hyperechoic (histology proven HCA).
Fig 13.2.7a Biliary Hamartoma (von Meyenburg complex). Hamartomas are initially hyperechoic (when small and mostly solid) (1, 2, 3) and of mixed echogenicity with cystic components (Zy) at later stage.
Fig 13.2.7b Biliary Hamartoma (von Meyenburg complex). Sometimes the liver parenchyma appears to be coarse and contains tiny cysts (arrows) and comet tail artefacts (arrowheads) on the ultrasound images
Fig 13.2.7c Biliary Hamartoma (von Meyenburg complex). Numerous tiny cysts are clearly delineated on the portal phase CT image
Fig 13.2.7d Biliary Hamartoma (von Meyenburg complex). Numerous tiny cysts are clearly delineated on T2-weighted coronal MR image
Fig 13.2.8a Focal fatty sparing (FFS) FFS typically shows centrally located feeding arterial vessels, with less insulin and fat concentration demonstrating the underlying pathological process of different vascularisation of the liver hilum
Fig 13.2.8b Focal fatty sparing (FFS) The arterial vessels can be displayed without fatty liver and, therefore, without FFS
Fig 13.2.8c Focal fatty sparing (FFS) The Doppler examination displays arterial spectrum
Fig 13.2.8e Focal fatty sparing (FFS) CT image in the arterial phase shows the aberrant left gastric artery (arrows) supplying the focal sparing
Fig 13.2.9 Focal fatty infiltration (FFI) In FFI changes in arterioportal venous perfusion have been suggested as the pathophysiological explanation with predominant portal venous flow and high content of insulin and fat)
Fig 13.2.10a Hepatocellular carcinoma (HCC). HCC might be hyperechoic, especially when small
Fig 13.2.10b Hepatocellular carcinoma (HCC). HCC are typically hypoechoic
Fig 13.2.10c Hepatocellular carcinoma (HCC). HCC show portal vein infiltration in up to 25 % of non-screened patients
Fig 13.2.10d Hepatocellular carcinoma (HCC). Regenerative nodules (RN) might show a size up to 35 mm.
Fig 13.2.11 Cholangiocarcinoma (CCC). Peripherally located CCC, slightly hypoechoic with satellite metastases (at surgery)
Fig 13.2.12a Metastases. Metastases might be small and iso- or slightly hypoechoic and difficult to detect
Fig 13.2.12b Metastases. Metastases might be small and iso- or slightly hypoechoic and difficult to detect
Fig 13.2.12c Metastases. Necrotic and larger metastases tend to be hypoechoic. Hyperechoic metastases may occur as well
Fig 13.2.13 Lymphoma. Circumscribed lymphomas can infiltrate the liver in small or large nodules or over an extended area, and depending on their rate of growth, are often very hypoechoic compared with the surrounding liver tissue
Fig 13.2.14 Abscess. The patient’s medical history and occasionally the physical examination (pyrexia or signs of sepsis) are the most helpful in differentiating abscesses from necrotic metastases
Fig 13.2.15 Hemorrhage. The spontaneously evolving and painful haematoma is typical for amyloidosis of the liver
Fig 13.2.16 Inflammatory pseudotumour. The definitive diagnosis is only achieved by surgery (wedge resection)
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