Liver Pathology (cysts, abscesses, masses)

hepatic cysts

may be solitary & idiopathic

may be associated w/ ADPKD or Von Hippel-Lindau disease

usually asymptomatic but pain can present w/hemorrhage, infection, or mass effect

hydatid liver cyst clinical & US

AKA echinococcal cyst from parasite echinococcus granulosus

tapeworm in dogs feces, contaminates food we eat or livestock that we eat

parasite moves through bowel & MPV into liver

clinical: leukocytosis, fever, nausea, obstructive jaundice, RUQ pain, recent travel abroad

US: anechoic mass w/some debris (hydatid sand), water lily sign, mother cyst containing daughter cyst(s), may have some dense calcifications

amebic hepatic abscess clinical & US

parasite that grows in colon invading liver via MPV

from contaminated water

can look similar to pyogenic abscess

if ruptured- high mortality rate

clinical: hepatomegaly, RUQ pain, malaise, diarrhea, fever, leuokcytosis, elevated LFTs, anemia, recent travel abroad

US: round, hypoechoic or anechoic, may have debris or debris layering. acoustic enhancement

schistosomiasis clinical & US

transmitted from contaminated water w/certain snails releasing parasites

can penetrate skin through bathing or injestion

clinical: fever, diarrhea, hepatomegaly, abdominal pain

US: bull’s eye lesion(s), anechoic center w/hyperechoic ring, periportal thickening, chronic = turtle back appearance

pyogenic abscess clinical & US

from spread of infection from inflammatory conditions already in body

variable appearance

clinical: fever, hepatomegaly, leukocytosis, RUQ pain

US: complex cyst w/thick walls, may have debris, septations &/or gas, air w/in may produce dirty shadows or ring-down artifact

hepatic candidiasis & US

spread of fungus

usually people who are immunocompromised in some way

US: multiple masses w/hyperechoic central portions & hypoechoic borders (bull’s eye), 1 cm or smaller, older lesions may calcify

cevrnous hemangioma clinical & US

most common benign tumor more in women & rt lobe

vascular but slow flow so not usually seen on doppler

clinical: aymptomatic

US: small, hyperechoic masses, most often in rt lobe, possibility for hypoechoic or complex appearance

focal nodular hyperplasia (FNH) clinical & US

2nd most common benign tumor more in women

not cause by oral contraceptive but can make mass grow bigger

varying appearances

referred to as stealth lesion b/c can hard to identify from normal liver parenchyma

clinical: aymptomatic

US: isoechoic, hyperechoic, or hypoechoic mass, linear central scar in mass may be hyper or hypoechoic & will have hypervascularity w/in scar

hepatocellular adenoma

AKA hepatic adenoma or liver cell adenoma

rare, benign tumor

associated w/oral contraceptive use

asymptomatic unless hemorrhage which can then become malignant (malignant degeneration)

often surgically removed due to malignant potential

clinical: asymptomatic, oral contraceptive use, pain w/hemorrhage

US: mostly hypoechoic, may be hyper or isoechoiuc or mixed echogenicities

hepatic lipoma

rarely encountered

asymptomatic hyperechoic mass

hepatic hematoma clinical & US

consequence of trauma or surgery

located intrahepatic or in Glisson capsule

solid or complex depending on age

following trauma, arteriovenous fistulas can also occur (look for them)

clinical: trauma, recent surgery, decreased hematocrit. pain

US: fresh blood clot = hyperechoic, older hemorrhage = anechoic or complex, intrahepatic or Glisson capsule, assess for arterivenous fistula

hepatocellular carcinoma (HCC) clinical & US

most common PRIMARY form of liver cancer mostly in men

clinical: elevated AFP, cirrhosis, chronic hepatitis, weight loss, hepatomegaly, fever, palpable mass, ascites

US: solitary hypoechoic mass, heterogenous masses scattered throughout, mass w/hypoechoic halo & central echogenic portion, possible ascites

hepatic metastasis clinical & US

liver is most common place for mets

**most common form of liver cancer (overall, not primary)**

diffuse mets can produce appearance of nodular liver (pseudocirrhosis) so look at capsule for small mets

clinical: abnd LFTs, weight liss, jaundice, RUQ pain, hepatomegaly, ascites

US: hyperechoic, hypoechoic, calcified, cystic, or heterogenous masses, mass w/hypoechoic ring & central echogenic portion, diffusely heterogenous liver, ascites

pediatric liver infantile hemangioendothelioma clinical & US

most common benign childhood tumor

usually found in first few weeks or months of life

clinical: pediatric patient, maybe hepatomegaly, maybe hemangiomas of the skin

US: homogenous or complex hepatic mass, may contain calcification or cystic spaces

peds hepatoblastoma clinical & US

most common peds malignant tumor

agressive tumor

high incidence w/Beckwith-Wiedemann syndrome

clinical: peds, asymptomatic, palpable mass, hepatomegaly, weight loss, anemia, pain, jaundice

US: solid, hyperechoic or heterogenous mass, may contain some calcs

contrast enhanced ultrasound (CEUS)

contrast injected to aid in identifying liver lesions for signs of malignancy

contrast contains small microbubbles that move into capillaries & travel to liver

95% specificity for determining benign vs. malignant