9%20ECOGRAFIA%20ABDOMINAL%20COMO%20CUANDO%20DONDE

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ABDOMINAL ULTRASOUND
E
F
G
H
Figure 4.16 cont’d (E) Large necrotic metastasis. (F) Miliary metastases affecting the entire liver. Some larger, focal
lesions are also visible. Note the hepatic enlargement and the lobulated outline of the liver. (G) Following
administration of microbubble contrast agent, numerous metastases are discovered. These appear hypoechoic in the
late portal venous phase, with no contrast uptake. (H) Calcified metastases from breast carcinoma.
possible primary carcinoma and to identify other
sites of carcinomatous spread. Lymphadenopathy
(particularly in the para-aortic, paracaval and portal
regions) may be demonstrated on ultrasound,
as well as invasion of adjacent blood vessels and
disease in other extrahepatic sites including spleen,
kidneys, omentum and peritoneum.
Doppler is unhelpful in diagnosing liver metastases,
most of which appear poorly vascular or avascular.
With the larger deposits, small vessels may be
identified most often at the periphery of the mass.
The use of microbubble contrast agents has
been shown to improve both the characterization
and detection of metastatic deposits on ultrasound.
8 The injection of a bolus of contrast agent
when viewed using pulse-inversion demonstrates
variable vascular phase enhancement with no contrast
uptake in the late phase (Fig. 4.16G).
Clinical features and management of liver
metastases
Many patients present with symptoms from their
liver deposits rather than the primary carcinoma.
The demonstration of liver metastases on ultrasound
may often prompt further radiological inves-