Diagnostic ultrasound ( PDFDrive )

118 PART II Abdominal and Pelvic Sonography
A
B
C
D
FIG. 4.53 Bleeding Hepatic Adenomas. (A) and (B) Sonograms of two young women presenting with acute abdominal pain from hemorrhage
into hepatic adenomas. The masses are highly complex, and their appearance in a patient with pain suggests hemorrhage into a preexisting lesion.
(C) Unenhanced and (D) enhanced computed tomography scans of the patient in B show the value of the unenhanced scan, which conirms the
high-attenuation blood within the adenoma.
and near the diaphragm, in which case diferential sound transmission
through the fatty mass will produce a discontinuous or
broken diaphragm echo 170 (Fig. 4.54A). CT or MRI can be used
to conirm the fatty nature of a mass (Fig. 4.54B). Angiomyolipomas,
by comparison, may also appear echogenic on sonography
(Fig. 4.54C), although they may have insuicient fat to appear
consistently with fatty attenuation on CT, making diagnostic
conirmation more diicult without biopsy.
Malignant Hepatic Neoplasms
Hepatocellular Carcinoma
HCC is one of the most common malignant tumors, particularly
in Southeast Asia, sub-Saharan Africa, Japan, Greece, and Italy.
HCC occurs predominantly in men, with a male-to-female ratio
of approximately 5:1. Causal factors depend on the geographic
distribution. Although alcoholic cirrhosis remains a common
predisposing cause for hepatoma in the West, both hepatitis C and
hepatitis B are now of worldwide importance. hese viral infections
also account for the high incidence of HCC in sub-Saharan
Africa, Southeast Asia, China, Japan, and in the Mediterranean.
Of growing importance in the Western world, fatty liver with the
development of steatohepatitis is increasingly important as an
antecedent to the development of cirrhosis and HCC. HCC is one
of the only solid tumors in North America with an increasing
incidence credited almost solely to the increasing signiicance
of nonalcoholic fatty liver disease. Alatoxins, toxic metabolites
produced by fungi in certain foods, have also been implicated
in the pathogenesis of hepatomas in developing countries.
he clinical presentation of HCC is oten delayed until the
tumor reaches an advanced stage. Symptoms include right upper
quadrant pain, weight loss, and abdominal swelling when ascites