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Chapter 4
79
Pathology of the liver and portal
venous system
CHAPTER CONTENTS
Benign focal liver lesions 79
Simple cysts 79
Complex cysts 80
Polycystic liver 81
Hydatid cyst 82
Abscesses 82
Haematoma 84
Haemangioma 85
Adenoma 86
Focal fatty change 87
Focal nodular hyperplasia 88
Granuloma 88
Hepatic calcification 88
Malignant focal liver lesions 89
Metastases 90
Hepatocellular carcinoma 93
Cholangiocarcinoma 95
Diffuse liver conditions 95
Fatty infiltration 95
Cirrhosis 97
Portal hypertension 99
Hepatitis 106
Primary sclerosing cholangitis 107
Budd–Chiari syndrome 107
Cystic fibrosis 109
Congestive cardiac disease 109
Liver conditions in pregnancy 109
Liver transplants 110
Indications for transplant 110
Preoperative assessment 111
Operative procedure 112
Postoperative assessment 113
Postoperative ultrasound appearances 113
Ultrasound is often the first line of investigation
for suspected liver pathology and the decision to
proceed to secondary investigative procedures,
such as further radiology or histology, is frequently
determined by the findings of the initial ultrasound
scan. Ultrasound is used in the diagnosis, staging
and monitoring of liver disorders and also contributes
to their treatment with ultrasound-guided
invasive procedures.
Increasingly, ultrasound is also a reliable tool for
more focused, complex examinations. Developing
technology and techniques now result in improved
diagnostic accuracy and are increasingly obviating
the need for further radiology.
Intraoperative and laparoscopic ultrasound, using
high-frequency, direct-contact techniques, set the
standard for liver imaging in many cases.
BENIGN FOCAL LIVER LESIONS
Simple cysts
One of the most frequently seen liver lesions, the
simple cyst, is either congenital (from abnormal
development of a biliary radicle) or acquired (from
trauma or previous infection). It is asymptomatic,
unless large enough to cause a ‘mass effect’, compressing
and displacing adjacent structures, and is