URR CTL Pathology 42% Liver

Which of the following is true regarding a liver hemangioma?

Color Doppler is not usually helpful in evaluating this highly vascular mass

What is the yellow are pointing to

thrombus in the portal vein

Periportal cuffing is a sign of:

acute viral hepatitis

All of the following statements correctly describe infantile hemangioendothelioma, except:

Highly aggressive liver malignancy seen early in life

Which of the following would indicate a normal Doppler evaluation of an intrahepatic shunt?

hepatofugal flow in the left portal vein

____________ is the most common cause for micronodular cirrhosis and ______________ is the most common cause of macronodular cirrhosis.

alcohol consumption, viral hepatitis

Which of the following correctly describes peliosis hepatis?

The primary finding that differentiate liver mass formation from steatosis is:

Steatosis will demonstrate normal vessel course through affected areas, while mass formation displaces vasculature

Which of the following is commonly associated with contaminate water and causes debris/occlusion within intrahepatic portal venous system?

schistosomiasis

A liver ultrasound demonstrates a hyperechoic mass with smooth borders and posterior enhancement in the posterior right lobe. These findings are most suggestive of:

cavernous hemangioma

___________abscesses are most commonly found in countries outside the UD. _________abscesses are most commonly seen in immunosuppressed patients.

amebic, fungal

__________ is the most common malignancy of the liver seen in a patient with AIDS. ___________is the most common infection of the liver seen in a patient with AIDS.

Kaposi sarcoma, pneumocystis carinii

Which of the following findings indicates a failed transjugular intrahepatic shunt?

hepatofugal flow in the main portal vein

A 75yr old female presents with RUQ pain. She was diagnosed with cirrhosis 4 yrs ago. Lab values demonstrate increase levels of alpha fetoprotein, ALP, AST, and ALT. The US exam deomstrates a heterogeneous liver texture that is decrease in size. The left lobe contains a new round hypoechoic mass with increased vascularity. These findings are most suggestive of:

Hepatocellular carcinoma

Which of the following Doppler parameters is most commonly used when evaluating the common hepatic artery in patient with a liver

Resistive index

A patient is referred for an abdominal ultrasound after a CT demonstrated a possible mass near the fundus of the gallbladder. The ultrasound demonstrates mild hepatomegaly with a mild diffuse increase in echogenicity. The area in question appears hypoechoic to the surrounding tissues. Theses findings are most suggestive of:

focal fatty sparing

Liver hemangiomas are a common benign neoplasm that will usually appear on an US of a normal liver as:

Well defined, hyperechoic liver mass

Which of the following findings will indicate hepatomegaly is present?

When the right lobe is rounded inferiorly and extends below the lower pole of the right kidney, the liver is considered enlarged.

A cyst within s cyst (daughter cyst) is a classic sign of

Hydatid cyst or Echinococcal cyst

A TIPS shunt is placed into the liver circulation to alleviate portal HTN. What two vessels are usually connected?

right portal vein connects to the right hepatic vein

Which of the following correctly describes how to determine if a peripheral mass is intrahepatic or extrahepatic?

Asses the liver capsule and look for indentations that indicate extrahepatic origin or outward bulging that indicates intrahepatic origin

What fetal syndrome is most commonly associated with hepatoblastoma

Beckwith-Wiedemann Syndrome

Steatosis refers to:

Fatty Liver disease

If this is a transverse view of the liver, where is the liver mass located?

anterior right

A patient presents with abdominal pain for 3 months following a missionary trip to India. Lab values demonstrate normal LFTs. The US exam demonstrates a 3cm cyst with septations in the right lobe of the liver. These findings are most consistent with:

hydatid disease

A patient is scheduled for abdominal ultrasound every six months due to their history of cirrhosis. What is the primary reason for these serial exams?

Increase risk of portal thrombosis

About 50% of all primary tumors that metastasize to the liver are drained through the:

Portal vein

A patient is referred for a RUQ scan with a 4yr history of treatment for AIDS. The liver demonstrates diffuse presentation of multiple calcifications of different sizes, with and without shadowing. These findings are most consistent with:

pneumocystic carinii

What is the most common liver malignancy identified on ultrasound?

metastatic tumor

A 43-year-old female with a history of hepatitis C presents with jaundice, increased abdominal girth and pain. The most probable US finding in the liver will be:

Cirrhosis and ascites

Which of the following is a potential collateral pathway formed in patients with cirrhosis?

blood moves from the SUPERIOR rectal vein to MIDDLE rectal vein

Which liver pathology is most commonly associated with the gallbladder pathology demonstrated on the image?

Hepatitis

Benign liver masses will usually demonstrate ultrasound contrast enhancement during the arterial and portal venous phases of imaging. Malignant masses will usually demonstrate:

contrast enhancement during the arterial phase of imaging

Which of the following liver tumors is usually treated by surgical resection due to risk of hemorrhage and malignant transformation?

Adenoma

When reviewing a prior US exam for an upcoming follow up exam for the same patient, you come across an image labeled "sandwich sign" what are they referring to

lymphadenopathy surrounding the portal vei

A patient presents with increasing RUQ pain and vomiting after a recent liver biopsy. An irregular mass with internal debris and an overall heterogenous appearance is noted in the right lobe. The mass also demonstrates several echogenic foci with ringdown artifact. These findings are most suggestive of:

Abscess

Liver transplant evaluation requires PW Doppler evaluation of all of the following, except:

biliary anastomosis

A patient presents with a history of hepatitis C and you identify a solid liver mass with a hypoechoic halo, This finding is most consistent with:

hepatocellular carcinoma

A 50yr old female presents with nausea, vomiting and increased levels of AFP in lab testing. Which of the following pathologies is demonstrated on the image displayed?

Klatskin tumor

A patient presents with a recent history of gastric carcinoma diagnosis. The image most likely demonstrates which of the following abnormalities?

metastatic lesions

How can a hepatic adenoma be differentiated from focal nodular hyperplasia (FNH) on contrast enhanced ultrasound?

FNH lesions usually demonstrate centrifugal enhancement while adenomas demonstrate centripetal enhancement

Which of the following describes a non-infectious cause for hepatitis?

Anabolic steroids

A _____________ abscess is caused by bacteria and most commonly forms withing the right lobe of the liver. A __________abscess is caused by a parasite and usually forms in the right dome of the liver causing elevation of the diaphragm.

pyogenic, amebic

A 26yr old female presents for an abdominal ultrasound. Her clinical history includes current use of oral contraceptive and mild hyperglycemia. The sagittal image of the liver is most suggestive of:

Adenoma formation in the right lobe, posteriorly

Fulminant hepatitis is most commonly caused by:

Acetaminophen abuse

A patient presents with lower extremity edema and increase abdominal girth 2 weeks after a liver transplant. These findings are most suggestive of what complication?

hepatic vein stenosis

If discovered in early stages, which of the following effects on the liver can be reversed?

Fatty infiltration

Which metabolic infiltrative disorder is associated with hepatic adenoma formation?

Von Gierke

Triglyceride accumulation in the liver leads to ______________, while copper accumulation in the liver leads to ___________.

steatosis, Wilson disease

Which of the following is true regarding a liver hemangioma?

A hemangioma is composed of an abnormal concentration of vascular tissue within the liver.

A liver mass with a hypoechoic rim should create a strong suspicion of:

malignancy

A mass that presents with a bull's eye appearance within the liver tissue is most likely ________________.

metastasis

A patient presents for a follow up ultrasound due to Budd Chiari syndrome. Which of the following is an expected finding on the exam?

thrombosis of the hepatic veins with hepatic congestion

Which of the following statements is true regarding the displayed image?

Bilirubin, AST, and ALT levels will be elevated.

Which liver disorder leads to the sonographic appearance of hepatomegaly with decreased echogenicity and scattered bright portal reflections within the parenchyma?

acute viral hepatitis

A 6 month old female is referred for an abdominal ultrasound due to suspected Kasabach-Merritt syndrome. What are you looking for on the exam?

liver or spleen hemangioma formation

A 10 year old presents for an abdominal ultrasound with palpable RUQ mass. He has no history of liver disease and alpha-fetoprotein levels are normal. You identify a 9cm mass in the right lobe that demonstrates punctate calcifications and a central scar. These findings are most suggestive of?

Fibrolamellar Carcinoma

A patient presents with an isolated slight increase in liver function tests. You identify two hyperechoic, homogeneous masses in the area of the porta hepatis. These findings are most consistent with:

focal fatty infiltration

A patient presents with a history of AIDS and recent pneumocystis carinii infection. What changes to the liver do you expect to see on the ultrasound exam?

diffuse echogenic foci throughout the liver tissue

The ______________ lobe of the liver does not normally atrophy with chronic Budd Chiari Syndrome.

caudate

________________can lead to air within the portal venous system and ____________can lead to air within the biliary tree.

Ulcerative colitis, an ERCP

What is the most common cause of a hepatic abscess in the US?

cholangitis and cholecystitis

What usually causes an echinococcal cyst in the liver?

Ingestion of raw pork

The most common finding with congestive hepatomegaly is:

IVC dilation

Schistosomiasis is an ________ cause of portal HTN. Budd Chiari syndrome is an cause of portal HTN.

Intrahepatic presinusoidal, intrahepatic postsinusoidal

Which of the following statements is true regarding the Doppler evaluation of the liver vasculature

The hepatic artery is hepatopetak and the portal vein is hepatofugal.

The most frequent involved organ in metastatic disease is the:

Liver

A contrast enhanced ultrasound examination is performed on a patient with suspected hepatocellular carcinoma. What are the expected findings if the exam is positive for HCC?

hyperechoic lesions during the arterial phase and hypoechoic lesions during the portal venous phase

The US exam of a patients liver demonstrates a paten umbilical vein. The most common cause for this recanalization is:

Portal HTN

A resistive index over 0.8 in the common hepatic artery would be an expected finding in patients with:

portal hypertension and transplant regection

What type of liver infection/abscess is commonly associated with immunocompromised patients?

candidiasis

The most common benign liver tumor is:

Cavernous hemangioma

What is the most common primary cancer

GI tract

Which of the following sonographic characteristics is associated with Budd Chiari syndrome?

atrophied hepatic veins

Portalization of the hepatic veins is a commone finding in which of the following?

advance cirrhosis

A patient presents for a liver ultrasound due to a history of cirrhosis. While scanning in the subcostal sagittal plane, just to the left of midline, you obtain the images displayed below. Which of the following best describes the findings?

patent umbilical vein

A patient presents with new onset of jaundice 2 weeks after a liver transplant. This clinical finding is most suggestive of what complication?

biliary stricture

Hepatic artery hypertrophy is a common finding with:

cirrhosis

In patients with cirrhosis, what effect will deep inspiration have on the portal vein?

there will be minimal change in the portal vein diameter

Which of the following describes the Doppler appearance of liver transplant rejection?

High resistance flow in the hepatic artery

Liver elastography is used for:

staging of fibrosis

If a liver transplant patient has an interposition anastomosis, how does this affect your evaluation?

there will be two anastomosis sites in the IVC that must be evaluated

Which of the following is the most common cause for intrahepatic cholestasis?

hepatitis

Which of the following vessels will be abnormally dilated with significant portal HTN?

main portal vein and left gastric vein

Which of the following describes the appearance of the liver in a patient in the later stages of cirrhosis caused by viral hepatitis?

multiple nodules usually 1-5cm in size

While scanning the liver in a patient with chronic cirrhosis, you notice a tubular vessel connecting to the splenic vein just prior to its confluence with the SMV. Flow within the vessel is very low velocity, continuous and moving in a cephalic direction. Which of the following explains the ultrasound findings?

A dilated coronary vein is present which is a common complication of cirrhosis

Which of the following correctly describes how to differentiate a liver hemangioma from focal fatty infiltration?

hemangiomas can compress or displace surrounding structures, fatty infiltration has no mass effect.

What abnormality causes focal developmental lesions of the liver and is associated with congenital hepatic fibrosis, autosomal dominant polycystic disease and cholangiocarcinoma

biliary hemartomas

What liver complication is associated with cholangitis, diverticulitis and osteomyelitis?

Pyogenic abscess

Shear wave elastography can be used to assess the liver. Which of the following correctly describes the results of an abnormal exam?

higher values indicate liver fibrosis

Cirrhosis causes reduced serum albumin levels. What complication does this cause?

ascites and peripheral edema

Hyoalbuminemia associated with cirrhosis leads to :

gallbladder and bowel wall thickening

The most definitive sonographic sign of cirrhosis is:

Decrease liver size with coarse texture and nodule formation

compensatory enlargement of the caudate lobe occurs with which of the following?

cirrhosis and Budd Chiari syndrome

What is a potentially life threatening complication of portal HTN?

ruptured gastroesophageal varices

Reduced glycogen storage in the liver usually causes the liver parenchyma to have a Sonographic appearance similar to:

acute viral hepatitis

While scanning the liver in a patient with chronic cirrhosis, you notice a tubular vessel connecting to the left portal vein and exiting the liver coursing inferiorly. Flow withing the vessel is very low velocity, continuous and moving in a caudal direction. Which of the following explains the ultrasound findings?

A dilated umbilical vein is present which is a common complication of cirrhosis

Contrast enhanced ultrasound is used to determine the outcome of tumor ablation in the liver. If the procedure was a success, what are the expected findings on the image?

No contrast enters the lesion during the cardiac cycle

What condition is associated with prominent portal walls?

acute viral hepatitis

A 40yr old female patient presents with increasing RUQ pain over the last month, beginning upon returning from a trip to Indonesia. The findings on her exam are most consistent with:

Echinococcal cyst