Diagnostic ultrasound ( PDFDrive )

CHAPTER 4 The Liver 129
A
B
FIG. 4.62 Lymphoma of the Liver. (A) Sagittal and (B) transverse sonograms show small, focal hypoechoic nodules throughout the liver.
Lymphoma may also involve the liver diffusely without producing a focal sonographic abnormality.
A
B
FIG. 4.63 Pseudocirrhosis in Woman With Metastatic Breast Cancer. Older woman presented to emergency department with increased
abdominal girth. (A) Intercostal sonogram of the liver shows heterogeneous nodular parenchyma, surface nodularity, and ascites; all suggest cirrhosis.
(B) Unenhanced computer tomography image of the liver conirms the indings, including ascites, surface nodularity, and heterogeneous parenchyma.
Contrast enhancement did not suggest focal metastatic disease. At autopsy, diffuse breast metastases were found.
the arterial phase (Fig. 4.64 and Videos 4.12, 4.13, and 4.14).
herefore metastases will appear as black punched-out areas
within the enhanced parenchyma. Hypovascularity and rim
enhancement can also be shown.
Peripheral cholangiocarcinoma is an infrequent tumor
presenting with a solitary liver mass similar to a metastasis, both
on gray-scale images and CEUS. Capsular retraction may be
appreciated.
Hepatic involvement by Kaposi sarcoma, although frequent
in patients with AIDS at autopsy, is rarely diagnosed by imaging
studies. 207 Sonography has demonstrated periportal iniltration
and multiple small, peripheral hyperechoic nodules. 208,209
Because of the nonspeciic appearance of metastatic liver
disease, ultrasound-guided biopsy is widely used to establish
a primary tissue diagnosis. In addition, ultrasound is an excellent
means to monitor the response to chemotherapy in oncology
patients.
HEPATIC TRAUMA
he approach to the management of blunt hepatic injury is
becoming increasingly more conservative. Surgical exploration
is indicated for patients who are in shock or hemodynamically
unstable. In the hemodynamically stable patient, many institutions