Unit 6 - Liver Pathology 68-90 ~ ZOEY

Budd-Chiari Syndrome

-thrombosis of HVs or IVC

-has a poor prognosis

Hepatic Circulation Primary Types:

congenital nonperforation

Hepatic Circulation Secondary Types:

-due to thrombosis in the IVC or hepatic veins

-oral contraceptives

-pregnancy

-hepatocellular carcinoma

-renal cell carcinoma

-adrenal carcinoma

-leiomyosarcoma of IVC

-infections

-trauma

-unknown etiology- 25 to 30%

Budd-Chiari Clinical Symptoms:

-ascites

-abdominal pain

-hepatosplenomegaly

-vomiting/diarrhea

-jaundice

Budd-Chiari Sonographic Findings:

-enlarged caudate lobe

-atrophy of Rt. Hepatic Lobe

-atrophy of thrombosed hepatic veins

-change in portal flow direction (hepatopedal)

Budd-Chiari Lab Work:

mild to moderate increase

-aminotransferase

-alk phos

Urine

-albuminuria

Benign Masses Acquired Cysts

-often asymptomatic

-3-7% have cysts (dependent on age)

-occurs predominantly in women

Benign Masses Acquired Cysts

Sonographic Features:

-smooth well-defined borders

-thin-walled

-anechoic

-posterior enhancement

The two types of Benign Masses Congenital Cysts:

Polycystic Liver Disease (PCLD) and Polycystic Kidney Disease (PCKD)

Benign Masses Congenital Cysts coexists with…….

polycystic kidney disease (PCKD)

Benign Masses Congenital Cysts Sonographic Features:

-multiple

-anechoic

-well-defined

-acoustic enhancement

-vary in size

-cysts may be seen in liver, kidneys, pancreas, spleen, and ovaries

Abscess Location

-intrahepatic

-subphrenic

-subhepatic

Abscess Sonographic Findings

-complex mass

-good through transmission

-echogenic foci

Amebic Abscess is a:

hepatic parasite infection

-entamoeba histolytica

Amebic Abscess Oral-fecal route

reaches the liver via PV

Amebic Abscess Symptoms

-pain

-1/2 of stool/colon cultures negative for parasite

Amebic Abscess Ultrasound

-variable

-round/oval lesion

-hypoechoic to liver

-fine low-level echoes

-distal enhancement

Amebic Abscess Treatment

-Flagyl-antiprotozoal medication

-percutaneous drainage

Hepatic Candidiasis:

mycotic infection spread

-immunocompromised patient

-pregnancy

-hyperalimentation

Hepatic Candidiasis Clinical Characteristic

persistent fever in neutropenic patient with WBC returning to normal

Hepatic Candidiasis Sonographic Characteristics

-wheel within a wheel

-bull’s eye

-uniformly hypoechoic

-echogenic (calcifcation)

Chronic Granulomatous Disease

is a genetic disorder in which the phagocytes are unable to kill certain bacteria or fungi/immunodeficiency

-chronic infection by “nonpathogenic” organisms (catalase positive)

(pneumonia, osteomyelitis, diarrhea, abdominal and CNS abscess)

Chronic Granulomatous is fatal in ________ without treatment

childhood

Chronic Granulomatous Disease findings:

-recurrent pneumonia w/ abscess adenopathy

-hepatosplenomegaly

-calcified granulomata in liver, spleen, and lymph nodes

-gastric antral narrowing

Echinococcosis or Hydatid Disease =

tapeworm

Echinococcosis or Hydatid Disease Sonographic features:

-infectious cyst

-multiloculated

-grainy material in dependant portion of a cyst

-densely calcified mass

Pneumocystis Carinii

-HIV or immunodeficiency

-usually in lung, but becoming more common elsewhere

Pneumocystis Carinii Sonographic:

-range from diffuse tiny non-shadowing echogenicties to

-echogenic clumps (dense calcification) replacing liver parenchyma

Kaposi Sarcoma

-frequent in AIDS patients at autopsy

-rarely diagnosed by imaging

Kaposi Sarcoma Sonographically:

-periportal infiltration

-multiple small hyperechoic nodules