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CASE PRESENTATION

CASE PRESENTATION. By: Dr. SHAMSHAD KHAN TMO Radiology HMC. Case. A 23 year old female came with pain in right hypochondrium. LFT ’ s were normal Ultrasound abdomen was done Which is as …….

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CASE PRESENTATION

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  1. CASE PRESENTATION By: Dr. SHAMSHAD KHAN TMO Radiology HMC

  2. Case • A 23 year old female came with pain in right hypochondrium. • LFT’s were normal • Ultrasound abdomen was done • Which is as …….

  3. Diagnosis ?

  4. Polycystic liver disease

  5. Polycystic liver disease • About 10 to 13 % of individuals have cysts in liver either single or multiple • Mostly are asymptomatic • LFT’s are normal in most cases • Approx 45 % occur with polycystic kidney disease

  6. LIVER LESIONS on ULTRASOUND • Two main types . Benign lesions . Malignant lesions

  7. BENIGN • Cystic which may be • Simple Cysts • Abscesses • Parasitic cysts

  8. Cont…… • Hepato-Billiary Cystic lesions • Hemangioma • Caroli’s disease • Peliosis • Choledochal cyst • Veno -occlusive disease

  9. Cont……… • Hepatocellular • Focal Nodular Hyperplasia • Adenoma

  10. MALIGNANT • Hepatocellular carcinoma • Fibrolamellar HCC • Metastasis • Lymphoma • Hepatoblastoma

  11. CYSTS • Most common lesions • Have three main characteristics Anechoeic lumen Increased through transmission Well enhanced posterior wall cont….

  12. Simple Cyst

  13. Simple Cyst with internal haemorrhage

  14. May be multiple as in poly cystic liver

  15. Cysts may be complex if they have Internal echoes Thick wall Septations Calcification cont………

  16. Complex cysts include Hematomas Abscesses Echinococcus Hemorrhagic tumors

  17. Abscesses • May be Bacterial , Fungal or amoebic Bacterial abscesses are caused due to intestinal infection like appendicitis and diverticulitis or even caused by endocarditis.

  18. Cont… • They appear as complex fluid collections with mixed echogenisity. • They may mimic solid hepatic masses but the presence of through transmission will provide clue to liquefied nature of the mass. • They may calcify with healing

  19. Abscess

  20. Multiple Abscesses

  21. Ruptured Liver Abscess

  22. Amoebic liver abscess • Usually single but can be multiple • Typically located in right lobe of liver • 30 to 70% are single • Appear as homogenous hypoechoeic lesions, round or oval with well defined borders

  23. Amoebic liver abscess • Initial stage

  24. Amoebic liver abscess • Recently formed cyst

  25. Amoebic abscess of duration

  26. Fungal Abscesses usually occur in immunocompromised patients Most common organism is candida Mostly cause very small lesions (microabscesses) Larger lesions may occur

  27. cont…… • Typical appearance is target lesion with central echogenic region and peripheral hypoechoeic halo. • Every lesion may have hypoechoeic focus centrally caused by necrosis and fungal elements.

  28. Ultrasound features of hepatic candidiasis • “Wheel within a wheel” peripheral hypoechoeic area inner echogenic wheel central hypoechoeic nidus • Bull’s eye Hyperechoeic centre Hypoechoeic rim • Uniformly hypoechoeic progressive fibrosis • Echogenic calcification representing scar formation

  29. Multiple hypoechoeic lesions in acute mylogenous leukemia

  30. Hepato-Billiary Vascular Cysts • Hepato-Billiary Vasculature can also appear as Cysts as seen in Aneurysms Arterio-portal and Veno-portal fistulas Caroli’s disease Choledochal cyst

  31. Caroli’s disease • Rare inherited disorder characterized by dilatation of the intrahepatic bile ducts • Two types of Caroli disease simple or isolated case where bile ducts are widened by ectasia 2nd is complex called Caroli syndrome associated with hypertension and congenital hepatic syndrome

  32. Caroli’s disease with multiple intra hepatic cysts

  33. Caroli disease in 9 year old girl

  34. Choledochal cyst • Congenital disease causing cystic dilatation of bile ducts • Appears in 1st year of life with jaundice and sometimes with palpable mass

  35. Choledochal cyst in 1 year old boy

  36. Choledochal cyst

  37. Parasitic cysts • Usually caused by Ecchinococcus granulosus • Liver is most commonly affected organ Have an external membrane ectocyst and an internal germinal layer called endocyst.

  38. cont…… • In addition forms a cyst around called pericyst. • Appear on ultrasound as a simple cyst with internal daughter cysts with detatched membranes , with internal debris and cysts, and with internal or peripheral calcification.

  39. Hydatid cyst

  40. Hydatid Cyst with Detached membranes

  41. BENIGN HEPATOCELLULAR LESIONS • Hemangiomas • Most common benign liver neoplasm occuring in 7 % of adults • More common in women than in men • Usually single but 10 percent are multiple

  42. cont……… • If small, they are asymptomatic • But if large, they have symptoms due to mass effect.

  43. Small hemangiomas ( less than 3cm ) typically appear as homogenous hyper echoeic mass with sharp and smooth margins. • If large, they may be atypical as a result of thrombosis, fibrosis and necrosis. Calcification can occur but is rare

  44. Hemangioma

  45. Multiple Hemangiomas

  46. cont…… • Some percentage of atypical hemangiomas may have hyperechoeic periphery and hypoechoeic centre.This is REVERSE TARGET SIGN characteristic of hemangiomas and is rarely seen in malignant disease.

  47. Reverse Target sign.

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