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Malignant focal liver lesions

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 .

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Malignant focal liver lesions

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  1. Malignant focal liver lesions

  2. Metastasis Liver is a most common site of metastatic disease

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

  4. 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 ).

  5. Metastasis

  6. Metastasis Bull’s eye appearance

  7. Metastasis Notes :- When searching for liver metastasis , a full scan of the whole abdomen is necessary . Lymphadenopathy may be difficult to demonstrate on ultrasound

  8. Hepatocellular carcinoma Predisposing factors Hepatitis Cirrhosis Drug related liver diseases

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

  10. Hepatocellular carcinoma Ultrasound appearance :- Small lesion in cirrhotic liver can be missed HCC may be hypoechoic , hyperechoic or mixed echopattern May be solitary or multiple

  11. Hepatocellular carcinoma

  12. Hepatocellular carcinoma

  13. Diffuse liver diseases

  14. Diffuse fatty infiltration of the liver Caused by accumulation of fat within the hepatic cells Predisposing factors :- Alcoholism Obesity Diabetes

  15. Diffuse fatty infiltration of the liver Ultrasound 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

  16. Diffuse fatty infiltration of the liver Intrahepaticvessel borders cannot be visualized Nonvisualizationof diaphragm in sever cases

  17. Diffuse fatty infiltration of the liver

  18. Diffuse fatty infiltration of the liver Notes :- Fatty infilteration itself is not usually a significant findings . Infilterationoften occurs in conjunction with other diffuse processes as cirrhosis . Its increased attenuation reduces the ability of ultrsound to exclude other disease or focal lesions .

  19. 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 .

  20. 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.

  21. Cirrhosis Clinical picture :- Pruritis Fatigue Jaundice Steatorrhea Raised alkaline phosphatase and serum bilirubin Signs of portal hypertension

  22. Cirrhosis increased echogenicity, coarse, heterogenous Nodular surface Regenerating nodules: hypoechoic Unequal distribution of cirrhosis in different segments Ultrasound picture at first hepatomegally then average size then shrunken

  23. Cirrhosis Portal hypertension * Collaterals: left gastric, paraesophageal, gastric , portahepatis, splenorenal and gall bladder wall * Splenomegaly Ascites

  24. Cirrhosis Complications Hepatocellular carcinoma (HCC) occurs in 10% of patients with cirrhosis; Esophageal varices with bleeding

  25. Cirrhosis

  26. Cirrhosis

  27. Thank you

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