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PATHOLOGY OF THE LIVER AND PORTAL VENOUS SYSTEM 97
focal lesions and therefore CT is often a useful
adjunct.
Cirrhosis
Cirrhosis is a process associated with end-stage
chronic liver disease and is not really a disease in
itself. It can result from a wide range of pathological
processes including chronic hepatitis and alcoholic
disease.
Ultrasound appearances of cirrhosis
In cirrhosis bands of fibrous tissue are laid down in
the liver parenchyma between the hepatic lobules.
This distorts and destroys the normal architecture of
the liver, separating it into nodules. The process may
be micronodular, which gives a generally coarse
echotexture, or macronodular in which discrete
nodules of 1 cm and above can be distinguished on
ultrasound (Fig. 4.20).
A
B
C
Figure 4.20 (A) Micronodular cirrhosis in a patient with alcoholic liver disease. (B) Macronodular cirrhosis in a
patient with primary biliary cirrhosis. Cirrhotic nodules are demonstrated throughout the peripheral hepatic substance
with a lobulated liver outline. Ascites is also present. (C) Monophasic ‘damped’ flow in the hepatic veins in a patient
with micronodular cirrhosis. This sign is not specific for cirrhosis and may be present under many other circumstances,
including the presence of ascites.