Diagnostic ultrasound ( PDFDrive )

1742 PART V Pediatric Sonography
A
B
C
D
FIG. 51.12 Cirrhosis. (A) Computed tomography (CT) scan of the upper abdomen in a 6-year-old child shows a small liver with multiple nodules
visible both along the cortex and within the liver. Microscopy of the native liver after transplantation showed regenerating nodules and severe
cirrhosis (portal hypertension). (B) Sonogram of another child shows macronodules of cirrhosis at the surface of the liver outlined by ascitic luid.
(C) Sonogram in a teenager with cystic ibrosis and cirrhosis shows diffusely increased echotexture of the liver. Note the nodular lateral surface of
the liver and the larger caudate lobe (CL). (D) Nodular contour may also be appreciated against a luid-illed gallbladder margin in patients without
ascites. This 17-year-old patient had autoimmune hepatitis and developing cirrhosis.
cirrhotic? Is there ascitic luid available for cytology? Is there
another abdominal, retroperitoneal, para-aortic, or pelvic
mass that could be a primary tumor?
Benign Liver Tumors
About 40% of primary liver tumors in children are benign.
Hemangiomas are by far the most common. Mesenchymal
hamartomas, adenomas, and focal nodular hyperplasia together
constitute about one-half of benign liver tumors in the child. 33
Hemangiomas
Hemangiomas are vascular, mesenchymal masses that may be
focal (solitary), multifocal, or difuse. All are characterized initially
by active endothelial growth (angiogenesis). During this stage,
the tumor is highly vascular and may cause suicient arteriovenous
(AV) shunting to result in high-output heart failure. When
associated with hydrops or congestive heart failure and thrombocytopenia,
this lesion may be called neonatal hemangiomatosis.
Hemangiomas in the liver are oten associated with cutaneous