2 Liver is a most common site of metastatic disease MetastasisLiver is a most common site of metastatic disease
3 Metastasis Clinical presentation:- Jundice Rt sided pain Hepatomegally Increase abdominal girth from ascitesAltered liver function tests
4 Metastasis Ultrasound appearance :- If very small can be missed Solid focal lesion with ill defined marginMay be hypoechoic , hyperechoic , isoechoic or mixed patternMass effect on adjacent structuresCalcifications may be seenOther features as lobulated outline of the liver , hepatomegally , ascites and lymphadenopathy ( para-aortic , para-caval and portal region ).
14 Diffuse fatty infiltration of the liver Caused by accumulation of fat within the hepatic cellsPredisposing factors :-AlcoholismObesityDiabetes
15 Diffuse fatty infiltration of the liver Ultrasound appearance :-The liver appears hyperechoicAs the level of fat deposition increases , the level of echogenicity may reach that of the highly reflective portal tract walls .The liver appears smooth and homogenous ( ground glass appearance )The contrast between the liver and RT kidney is increased
16 Diffuse fatty infiltration of the liver Intrahepatic vessel borders cannot be visualizedNonvisualization of diaphragm in sever cases
18 Diffuse fatty infiltration of the liver Notes :-Fatty infilteration itself is not usually a significant findings .Infilteration often occurs in conjunction with other diffuse processes as cirrhosis .Its increased attenuation reduces the ability of ultrsound to exclude other disease or focal lesions .
19 CirrhosisCirrhosis is defined as hepatic fibrosis with the formation of nodulesBands of fibrous tissue are laid down in the liver parenchyma between the hepatic lobules leading to distortion of and destruction the normal architecture of the liver separating it into nodules .
20 CirrhosisCirrhosis is not a disease itself but it is a process associated with end stage chronic liver diseaseIt can result from chronic hepatitis , alcoholic diseaseCongenital form :- glycogen storage disease , haemochromatosis and wilson’s disease.
21 Cirrhosis Clinical picture :- Pruritis Fatigue Jaundice Steatorrhea Raised alkaline phosphatase and serum bilirubinSigns of portal hypertension
22 Cirrhosis Ultrasound picture at first hepatomegally then average size then shrunkenincreased echogenicity, coarse, heterogenousNodular surfaceRegenerating nodules: hypoechoicUnequal distribution of cirrhosis in different segments
23 Cirrhosis Portal hypertension * Collaterals: left gastric, paraesophageal, gastric , porta hepatis,splenorenal and gall bladder wall* SplenomegalyAscites
24 Cirrhosis Complications Hepatocellular carcinoma (HCC) occurs in 10% of patients with cirrhosis;Esophageal varices with bleeding