Pathology

What is liver agenesis?

Absence of liver formation

What is partial situs inversus?

When abdominal contents are reversed

What is complete situs inversus?

When chest and abdominal contents are reversed

What is a Reidel lobe?

When right lobe of live extends below lower pole of right kidney

What is an elongated left lobe?

When left lobe of liver extends into LUQ

What is a hepatic cyst?

Fluid filled space with an endothelial lining

What is a hemorrhagic hepatic cyst?

When blood leaks into an existing cyst due to hemorrhage or infection and creates a complex appearance

What is polycystic liver disease (PCLD)?

Prescence of multiple cysts that do NOT communicate with biliary tree

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Polycystic liver disease (PCLD)

What is a biliary hamartoma or von Meyenburg Complexes?

Dilated intrahepatic ducts that appear as small echogenic nodules with ringdown and twinkle artifact

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Biliary hamartoma or von Meyenburg Complexes

What is fatty infiltration of the liver or hepatic steatosis?

Triglyceride accumulation in liver cells most commonly caused by obesity

What is alcoholic fatty liver disease?

Fatty liver caused by chronic alcohol intake that can lead to alcoholic hepatitis

What is the most common chronic liver disease in Western countries?

Nonalcoholic fatty liver disease

What is nonalcoholic fatty liver disease?

Ftty liver caused by diabetes, obesity, and TB that can lead to nonalcoholic steatohepatitis (NASH)

What is the sonographic appearance of fatty liver disease or hepatic steatosis?

1. Increase in liver echogenicity

2. Hepatomegaly

3. Rounding of inferior liver border

4. Fatty sparing appears as focal areas of normal echogenicity near GB

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Mild fatty liver

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Severe fatty liver

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Fatty sparing

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1. Hemangioma seen with “mass effect” on other structures and vessels

2. Fatty infiltration seen with no displacement of other tissues

What is Reye Disease?

Disease associated with aspirin use during viral infection that causes excessive fat accumulation in liver with an acute increase in cranial pressure

What is amyloid disease?

Deposition of amyloid protein in vessel walls leading to organ failure

What is glycogen storage or von Gierke disease?

Excessive or reduced storage of glycogen within hepatocytes

What is the sonographic appearance of excessive glycogen storage or von Gierke disease?

1. Increased liver echogenicity

2. Hepatomegaly

3. Adenoma formation

What is the sonographic appearance of reduced glycogen storage or von Gierke disease?

1. Decreased liver echogenicity

2. Prominent appearance of portal walls

3. “Starry sky” appearance

What is hemochromatosis?

Abnormal iron deposition in organs that leads to fibrosis and cirrhosis with NO change in liver reflectivity

What is Wilson disease?

Excessive deposition of copper in liver and brain that leads to hepatic dysfunction, hepatitis, and cirrhosis

What are the symptoms associated with Wilson disease?

1. Jaundice

2. Hematemesis

3. Portal HTN

4. Ascites

5. Kayer-Fleischer rings or brown colored rings around iris of eyes

What is the sonographic appearance of Wilson disease?

1. Increased liver echogenicity

2. Hepatomegaly

3. Fibrotic periportal thickening

4. Nodular cirrhotic changes

What is the difference between fatty liver disease and cirrhosis?

Fatty liver disease is reversible while cirrhosis is irreversible

What is cirrhosis?

Diffuse liver disease caused most commonly caused by alcoholism and hepatitis C

Cirrhosis is associated with…

Hepatocellular carcinoma (HCC)

What are the symptoms of cirrhosis?

1. Increased abdominal girth from ascites

2. Jaundice

3. Weight loss

What is the sonographic appearance of early cirrhosis?

1. Increased liver echogenicity

2. Hepatomegaly

3. Heterogenous parenchyma

What is the sonographic appearance of late stage cirrhosis?

1. Decreased liver size commonly sparing caudate lobe

2. Coarse texture

3. Nodule formation (micro < 1 cm, macro 1 - 5 cm)

4. Ascites

5. Splenomegaly

6. Portal HTN or thrombosis

7. Narrowed hepatic veins

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Cirrhosis

What is the most common cause of intrahepatic cholestasis?

Hepatitis

What is hepatitis?

Inflammation of liver most commonly spread by IV drug users

What is the most common chronic bloodborne infection in the US?

Hepatitis C

What are the different types of hepatitis?

1. Hepatitis A: Fecal-oral

2. Hepatitis B: Blood-borne

3. Hepatitis C: Blood-borne

4. Hepatitis D, E, G are less common

What is alcoholic hepatitis?

Acute liver inflammation caused by prolonged heavy alcohol abuse

What is the sonographic appearance of acute alcoholic hepatitis?

1. Diffuse increase in liver echogenicity

2. Hepatomegaly

3. CHA PSV > 100 cm/sec

4. Dilated CHA

What is the sonographic appearance of chronic alcoholic hepatitis?

Atrophied liver with micronodular cirrhosis

What is nonalcoholic steatohepatitis (NASH)?

Consequence of nonalcoholic fatty liver disease

What is fulminant hepatitis?

Inflammation that leads to acute liver failure caused by acetaminophen overdose

What is the sonographic appearance of acute hepatitis?

1. Decreased liver echogenicity

2. Hepatomegaly

3. “Starry sky” appearance

4. Ascites

5. Cholecystitis

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Acute hepatitis

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Acute hepatitis

What is chronic hepatitis?

Persistence of hepatitis infection for more than 6 months

What is the sonographic appearance of chronic hepatitis?

1. Diffuse increase in liver echogenicity

2. Atrophied liver

3. Decreased echogenicity of portal vein walls

4. Granuloma formation

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Chronic hepatitis

What is a echinococcal or Hydatid cyst?

Cysts formed from tapeworms found in feces of infected animals

What is the sonographic appearance of a echinococcal or Hydatid cyst?

1. Early stages seen as cyst with debris or Hytadid sand

2. Late stage honeycomb sign seen as fluid collections with septa

1. Late stage water lily sign seen as fluid collection with split wall

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Early stage echinococcal or Hydatid cyst

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Late stage echinococcal or Hydatid cyst

What is the most common parasitic infection in humans?

Schistosomiasis

What is schistosomiasis?

Periportal fibrosis caused by parasitic infection from polluted waters or shellfish

What is the sonographic appearance of schistosomiasis?

1. Periportal fibrosis seen as thick, echogenic portal vein walls

2. Bull’s eye sign with portal veins

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Schistosomiasis

What is pneumocystis Jirovecci or Carinii?

Yeast-like fungus that commonly affects AIDS patients

What is the sonographic appearance of pneumocystis Jirovecci or Carinii?

Multiple non-shadowing echogenic foci within liver tissue

What are granulomatous infections?

Fungal respiratory disease caused by histoplasmosis and TB

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Granulomas

What is the most common form of liver abscess?

Pyogenic abscess

What is the most common cause of a pyogenic abscess?

Biliary disease

What is a pyogenic abscess?

Bacterial infection located in right lobe of liver

What is the sonographic appearance of a pyogenic abscess?

1. Complex cystic mass

2. Cluster sign seen as cluster of small abscesses

3. Reverberation or ringdown artifact

What is a fungal abscess or candidiasis?

Fungal infection seen in immunocompromised patients that causes a LOW WBC

What is the sonographic appearance of a fungal abscess or candidiasis?

1. Wheel within wheel

2. Hypoechoic ring around hyperechoic center

What is an amebic abscess?

Parasitic infection commonly located in right dome of liver

What is the sonographic appearance of an amebic abscess?

1. Round mass with indistinct walls

2. Low level internal echoes

3. Elevated diaphragm

4. Echogenic foci