Diagnostic ultrasound ( PDFDrive )

PART TWO: Abdominal and Pelvic Sonography
CHAPTER
4
The Liver
Stephanie R. Wilson and Cynthia E. Withers
SUMMARY OF KEY POINTS
• The liver is an ideal organ for sonographic evaluation
based on its large size, homogeneous parenchyma,
and location high in the abdomen with access
provided from both a subcostal and an intercostal
approach.
• Standard ultrasound with real-time gray-scale morphologic
assessment and Doppler evaluation of the liver vasculature
is augmented by newer techniques of contrast-enhanced
ultrasound and elastography.
• Fatty liver is considered an epidemic in North America, and
ultrasound is often the irst test to suggest its presence
and severity.
• Ultrasound performed at 6-month intervals is the
recommended surveillance method for detection of
nodules in the liver of those at risk for the development of
hepatocellular carcinoma.
• Ultrasound is the method of choice for the guidance of
interventional procedures performed on the liver, including
ablation techniques in those with malignant tumors, biopsy
of liver masses, and the insertion of therapeutic devices
such as drainage tubes and transjugular intrahepatic
portosystemic shunts.
• Intraoperative ultrasound of the liver allows for detection
of previously unidentiied tumors.
CHAPTER OUTLINE
SONOGRAPHIC TECHNIQUE
NORMAL ANATOMY
Couinaud Anatomy
Ligaments
Hepatic Circulation
Portal Veins
Arterial Circulation
Hepatic Venous System
Normal Liver Size and Echogenicity
DEVELOPMENTAL ANOMALIES
Agenesis
Anomalies of Position
Accessory Fissures
Vascular Anomalies
CONGENITAL ABNORMALITIES
Liver Cyst
Peribiliary Cysts
Autosomal Dominant Polycystic
Disease
Biliary Hamartomas (von Meyenburg
Complexes)
INFECTIOUS DISEASES
Viral Hepatitis
Clinical Manifestations
Bacterial Diseases
Fungal Diseases: Candidiasis
Parasitic Diseases
Amebiasis
Hydatid Disease
Schistosomiasis
Pneumocystis carinii
DISORDERS OF METABOLISM
Fatty Liver
Glycogen Storage Disease
(Glycogenosis)
Cirrhosis
Doppler Ultrasound Characteristics
Elastography
VASCULAR ABNORMALITIES
Portal Hypertension
Portal Vein Thrombosis
Budd-Chiari Syndrome
Portal Vein Aneurysm
Intrahepatic Portosystemic Venous
Shunts
Aneurysm, Pseudoaneurysm, and
Dissection
Hereditary Hemorrhagic Telangiectasia
Peliosis Hepatis
HEPATIC MASSES
Liver Mass Characterization
Role of Microbubble Contrast
Agents
Liver Mass Detection
HEPATIC NEOPLASMS
Benign Hepatic Neoplasms
Cavernous Hemangioma
Focal Nodular Hyperplasia
Hepatic Adenoma
Fatty Tumors: Hepatic Lipomas and
Angiomyolipomas
Malignant Hepatic Neoplasms
Hepatocellular Carcinoma
Hemangiosarcoma (Angiosarcoma)
Hepatic Epithelioid
Hemangioendothelioma
Metastatic Liver Disease
HEPATIC TRAUMA
Portosystemic Shunts
Transjugular Intrahepatic
Portosystemic Shunts
PERCUTANEOUS LIVER BIOPSY
INTRAOPERATIVE ULTRASOUND
Acknowledgment
74