6 Polycystic liver disease About 10 to 13 % of individuals have cysts in liver either single or multipleMostly are asymptomaticLFT’s are normal in most casesApprox 45 % occur with polycystic kidney disease
7 LIVER LESIONS on ULTRASOUND Two main types. Benign lesions. Malignant lesions
8 BENIGNCystic which may beSimple CystsAbscessesParasitic cysts
18 Abscesses May be Bacterial , Fungal or amoebic Bacterial abscesses are caused due to intestinal infection like appendicitis and diverticulitis or even caused by endocarditis.
19 Cont…They appear as complex fluid collections with mixed echogenisity.They may mimic solid hepatic masses but the presence of through transmission will provide clue to liquefied nature of the mass.They may calcify with healing
23 Amoebic liver abscess Usually single but can be multiple Typically located in right lobe of liver30 to 70% are singleAppear as homogenous hypoechoeic lesions, round or oval with well defined borders
33 Hepato-Billiary Vascular Cysts Hepato-Billiary Vasculature can also appear as Cysts as seen inAneurysmsArterio-portal and Veno-portal fistulasCaroli’s diseaseCholedochal cyst
34 Caroli’s diseaseRare inherited disorder characterized by dilatation of the intrahepatic bile ductsTwo types of Caroli diseasesimple or isolated case where bile ducts are widened by ectasia2nd is complex called Caroli syndromeassociated with hypertension and congenital hepatic syndromeia
40 Parasitic cysts Usually caused by Ecchinococcus granulosus Liver is most commonly affected organHave an external membrane ectocyst and an internal germinal layer called endocyst.
41 cont……In addition forms a cyst around called pericyst.Appear on ultrasound as a simple cyst with internal daughter cysts with detatched membranes ,with internal debris and cysts,and with internal or peripheral calcification.
44 BENIGN HEPATOCELLULAR LESIONS HemangiomasMost common benign liver neoplasm occuring in 7 % of adultsMore common in women than in menUsually single but 10 percent are multiple
45 cont……… If small, they are asymptomatic But if large, they have symptoms due to mass effect.
46 Small hemangiomas ( less than 3cm ) typically appear as homogenous hyper echoeic mass with sharp and smooth margins.If large, they may be atypical as a result of thrombosis, fibrosis and necrosis.Calcification can occur but is rare
49 cont……Some percentage of atypical hemangiomas may have hyperechoeic periphery and hypoechoeic centre.This is REVERSE TARGET SIGN characteristic of hemangiomas and is rarely seen in malignant disease.
51 cont………Hemangiomas are stable over time but approx. 10 % undergo decrease in echogenecity5 % will regress partially or completelyOnly 2 % enlarge on follow up scans.
52 Focal Nodular Hyperplasia It is a benign tumor of liver composed of Kupffer cells, hepatocytes and billiary structures.2nd most common benign liver tumorBoth FNH and Hemangioma can occur simultaneouslyDevelop from congenital vascular malformation
53 cont………They are typically un encapsulated and often with central stellate scar20 % are multipleSupplied by internal arterial network arranged in spoke wheel pattern better displayed on doppler.More common in womenAsymptomatic until they are large
57 HEPATIC ADENOMABenign tumors that contain normal hepatocytes but few kupffer cells and no bile ductulesUsually common in women taking birth control pillsCan also occur in males taking anabolic steroids
58 cont……Multiple adenomas can occur in patients with type 1 Glycogen storage diseases called Hepatic AdenomatosisOn ultrasound most are homogenous and hypoechoeicCalcification may occur in 10% of cases
66 HEPATOCELLULAR CARCINOMA Most common primary malignancy of liver referred to as HEPATOMAStrong association with chronic liver disease like Hepatitis B, C and Alcoholic cirrhosisOther conditions include Hemochromatosis, Wilson disease and Type 1 Glycogen storage disease
67 cont……… May be solitary, mulifocal or diffuse and infiltrating Typical lesion is large with scattered smaller satellite lesions
75 CONCLUSIONUltrasound is best modality for differentiating solid from cystic lesions with real time imaging capabilities.However MRI and CT scan are performed in some cases to characterize the lesions.