V Difficult to differentiate from normal liver

parenchyma
V Supporting clinical findings:
Hepatosplenomegaly, ascites
V uost common liver pathology
V Increased echogenicity
V Decreased detail display of intra-hepatic
vascular architecture
V Focal hypoechoic areas
V @ aggerated echo difference between liver and
kidney (left picture is normal)
V Oircumscribed focal hypoechoic areas (focal
fatty sparing) in the liver hilum. In between
calipers is a focal liver lesion.
V ˜
 can be diagnosed accurately in patients
with complications (ascites, splenomegaly,
collaterals)
V Ooarse liver parenchyma and a disturbed or
destroyed vascular architecture as a sign of
portal hypertension - such as reversed portal
flow and collateral vessels - are other signs of
liver cirrhosis.
V ypical signs include inhomogenous echote ture
and irregular liver surface delineation (a).
V Distinctive nodules are suggestive (b).
V @arly and late stages of cirrhosis
V Diffuse increased heterogeneity and
echogenicity of hepatic echote ture
consistent with diffuse inflammatory process
from hepatitis
V Associated with gallbladder wall thickening
V he parenchymal echo pattern is typically of
increased echogenicity with abundant roundish
or oval foci of decreased echogenicity (between
callipers) resembling metastatic liver disease.
V °inear hyperechoic septations between
polygonal areas of hepatic parenchyma
producing a Dznetwork patterndz
V differences in echogenicity between a
circumscribed area and the surrounding liver
tissue
V frequent finding, easily detected by U
V Oompletely echo-free; with smooth and regular
outlines and dorsal acoustic enhancement in
relation to the size of the lesion
V Oongenital, usually familial
V uultiple cysts of varying size
 4
 





4
 cysts consist of pure fluid Fertile cysts with viable protoscolices
4
 have the characteristic
Dzwater lily signdz and Dzhydatid sanddz
*dz
 dz: Infoldings of the inner
cyst wall resulting in floating membrane
*Dz

Dz consists predominantly
of parts of protoscolices (hooklets and
scole es).
 4
 





4
 cysts contain daughter ransitional phase (integrity of the cyst
cysts has been compromised either by the host
*      by separation of or by medical treatment )
the hydatid membrane from the wall
4
 have a heterogeneous Inactive cysts with degeneration which
echo pattern (may be hyperechoic due to have lost their fertility
regressive changes)
4
 have a calcified wall
V Hypoechoic lesions
V Fairly large
V Inhomogenous
echote ture
V @.g. Amebic liver
abscess (may be
solitary, but several are
usually present)
V uost common benign liver tumor
V <3 cm in diameter
V Round, well-circumscribed
V Hyperechoic, homogenous inside
V young and middle-aged women
V benign, mostly incidentally discovered
hepatic neoplasia
V FNH: isoechoic tumour of variable size, with a
central scar and calcifications (5
Ȃ 8
)
V HOA: large, hyperechoic lesion with central
anechoic areas, corresponding to zones of
internal hemorrhage
V Öften appears isoechoic in comparison to the
surrounding liver parenchyma
V Oannot be differentiated from malignant
tumours like HOO
V °arge, solid echogenic mass
V uay be iso-, hypo-, or hyperechoic
V Heterogenous appearance
V Oan be very difficult to identify in patients
with liver cirrhosis
 Ô
  
 Ô 

: Ô
 
 


  
 Ô
  
 Ô 

: Ô
 
 


  
V he special features of portal vein circulation
favour hematogenic metastasization
V uultiple, focal masses
V Size and echogenicity metastases varies
V he more echogenic the masses, the masses
are likely to be more vascular in nature.
V @arly stages: hyperechoic
V °ater stages: iso- or mostly hypoechoic
V Dietrich OF, Serra O, Jedrzejczyk u.
¢
 

  Ë

.
V Holm HH, Kristensen JK, Rasmussen SN,
Pedersen JF, Hancke S, Jensen F,
Gammelgaard J, Smith FH. = 
¢
, Ënd ed. uunksgaard,  8
.