Abdominopelvic ADDIS

Ultrasound Assignment
ABABA
UNIVE
Prepared by Natnaiel
Getahun UGR/4239/13
RSITY
DEPAR COLLE
Submitted to: Mr.
Zegeye w. TMEN GE OF
Submission date:
July/2023
T OF HEALT
MRT H
SCIEN
CE

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 Simple hepatic cyst

Cystadenoma

Polycystic liver disease DIAGRAMMATIC

Anechoic
REPRESENTATION
Hepatic lymphoma
For benign and malignant focal liver
HCC
mass
Keys
Metastasis
 All lesions highlighted with
Cholangiocarcinoma
orange are malignant tumors but
all the remaining lesions are
Hepatic lymphoma benign.
 All listed on the diagram
Hypoechoic
HCC
classified based on the usual
manifestation not mean always.
Metastasis
 Heterogeneous Complex lesions
Hepatic focal lesions

and different appearances during

Hepatic adenoma
different times can’t include on
the diagram like Hematoma,
Hemangioma
Hydatid cyst and Abscess.
Granuloma

Lipoma

Hyperechoic

Focal fatty liver

HCC

Metastasis

Focal nodular hyperplasia

Cholangiocarcinoma

Isoechoic Hepatic lymphoma

HCC

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Metastasis
Hepatic myelolipoma
Hepatic myelolipoma is a rare, benign fat-containing lesion of the liver, usually asymptomatic
and found incidentally. Its diagnosis by imaging remains difficult because of a lack
of pathognomonic signs. The definite diagnosis is by resection or biopsy.
On US Appears as a hyperechoic well-circumscribed, lobulated mass and on Color
sonography of the hepatic mass. Vessels are identified inside the tumor.

Angiomyolipoma (AML)
Angiomyolipoma (AML) of the liver is a rare benign mesenchymal tumor that usually presents
in adult female patients; nonetheless, several cases have also been reported among males. AMLs
most frequently occur in the kidney, with the liver being the second most common site of
involvement. The drainage vein of AML is the hepatic vein, and identifying a perfusing vein
communicating with the hepatic vein from the tumor center can aid in differentiating AML from
fat-containing hepatocellular carcinoma (HCC)
On US it may be seen as hetero or homogeneous echogenic (due to fat content) mass lesion. In
the case of less fat content and excess vascular component, angiomyolipoma can be seen as a
heterogeneous hypoechoic mass lesion. Could be indistinguishable from a hemangioma. Hepatic
Infarction
 On power-Doppler ultrasound, they appeared avascular due to the low sensitivity of
Doppler techniques to detect capillary blood flow.

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  On ultrasound examination the lesion was round shaped and sharply delineated with a
homogenous hyperechoic echotexture.

Ultrasound shows echogenic angiomyolipoma in the left lobe of the hypoechoic liver
parenchyma on the left.

Hepatic Infarction
Hepatic infarction is an extremely rare situation because the liver has a dual blood supply from
the hepatic artery and portal vein. Hepatic infarction can occur when there is both hepatic arterial
and portal vein flow compromise but most cases are due to acute portal venous flow
compromise.
DDX
General imaging differential considerations include:
Focal hepatic steatosis: focal fatty infiltration also lacks mass effect, however vessels are
seen crossing through the lesion
Hepatic abscess: typically shows mass effect on adjacent structures and ring-
enhancement while hepatic infarction lacks mass-effect and any enhancement
True hepatic masses: both mass effect and enhancement differentiate from hepatic
infarction, and the clinical scenario is different
Emphysematous hepatitis: when gas is present, usually no mass effect
Ultrasound features
Acute stage
 An ill-defined hypoechoic area with indistinct border
 Gas within sterile infarcted zone can be seen
 Chronic stage
 Infarcted area becomes anechoic and cystic with distinct borders.

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Differentiation between gas within sterile infarcted area and abscess formation by imaging is
impossible and fine needle aspiration is needed.

Schistosomiasis
Schistosomiasis is one of the major tropical and sub-tropical diseases caused by
trematodal parasite of genus Schistosoma. This neglected disease affects 200 million people,
resulting in the loss of 1.53 million disability-adjusted life years (DALY). The disease presents
in wide spectrum including both acute and chronic forms, affecting multiple target organs. The
schistosomal infection is mainly diagnosed by demonstrating evidence of infestation by
parasitological, serological or molecular methods using samples such as stool, urine, blood or
other body fluids and tissue specimens. However, these test methods have their own limitations
in evaluating severity of morbidity.
Ultrasound is considered the primary modality of choice as it can pick characteristic
hepatosplenic and urinary lesions.
Schistosomiasis hepatic manifestations are a chronic result of the deposition of eggs into small
portal venules leading to periportal fibrosis and liver cirrhosis.
Typical ultrasonographic findings
 Periportal fibrosis,
 Hypertrophy of the left liver lobe,
 Atrophy of right liver lobe,
 Splenomegaly, and ascites.
 Dilated portal venous system,
 S. Japonicum
Septa and capsular calcifications
 S. Mansoni
Portal veins wall thickening and increased echogenicity
“bull’s-eye” appearance: an anechoic portal vein surrounded by echogenic fibrous tissue

Hepatosplenic schistosomiasis. A and B ultrasound images of liver showing typical

periportalfibrosis (curved arrow): as evidence of hepatic shistosomiasis. C shows enlarged spleen
with dilated spenic vein in same patient (straight arrow).

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Doppler sonography is valuable in assessing portal vein patency for intrahepatic portosystemic
shunt (TIPS) required to manage complicated portal hypertension.

Tuberculosis (TB)
Tuberculosis (TB) is a significant health problem. The lungs are the most commonly affected
organs, but TB may affect any organ system in the body, including the liver. Involvement of the
liver and the biliary system is mainly in association with miliary lung tuberculosis, though the
gastrointestinal system may also act as the source of the bacillus. The main route of spread of the
bacillus to the liver is hematogenous from the lungs via the hepatic artery. The portal vein was
reported to be another route for liver infection, especially in cases of gastrointestinal TB.
Lymphatic spread was also proposed as a gateway to liver infection. Isolated primary TB of the
liver is rare.
 Non-specific features are usually seen, including hepatosplenomegaly and abscesses.
 There may be small hypoechoic nodules (miliary type) or larger hypoechoic mass-like
areas

14-year-old girl with hepatic tuberculoma. Gray-scale

ultrasound shows hypoechoic solid lesion (arrow) that
was finally proven to be tuberculoma after
percutaneous biopsy.

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Sarcoidosis
Sarcoidosis is a systemic inflammatory disease of unknown origin characterised by the formation of non-
caseating granulomas. Virtually any organ system may be involved. Although less common
than pulmonary and mediastinal disease, abdominal sarcoidosis can mimic more common infectious or
neoplastic conditions (especially lymphoma) resulting in unnecessary morbidity.
Organs involved:
Liver and spleen are the most frequently involved viscera, with granulomata noted in 40-70% of patients
Renal involvement is seen in 8-19% of patients
Pancreatic, intestinal, and testicular sarcoidosis have been found in 5% or less of patients at autopsy

US feature of liver
(1) Hepatomegaly; (2) Coarse nodular pattern; (3) Hypoechoic and hypovascular nodules

Us feature of spleen
(1) Organ enlargement; (2) Hypo, iso or hyperechoic, hypovascular nodules

Focal nodules are also noted in the livers of patients with

hepatic sarcoidosis.

TOXOCARIASIS
Toxocariasis is caused by dog ascarid, Toxocara canis, forming eosinophilic inflammation such
as eosinophilic abscess or granuloma in the liver and lungs. The lesions move slowly and thus
the disease is called as visceral larva migrans.
 On sonography, the lesions appear as multiple, small, oval hypoechoic lesions in the liver
parenchyma.
The lesions are usually oval, angulated or trapezoid rather than round and their margins are ill
defined. Sometimes, lesions conglomerate to form a large lesion of mixed echogenicity
The lesions differ from metastatic nodules is as much as they have fuzzy margins, are uniform in
size, non-spherical shape and are best seen on portal venous phase.

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 A 35-year-old man with hepatic toxocariasis. Sonogram of the
liver shows two, ill-defined, slightly hypoechoic nodules
(arrows).

Reference
ULTRASOUND: THE REQUISITES 2nd edition

https://link.springer.com/article/10.1007/s40477-014-0137-y

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3430108/

https://liveratlas.org/case/259/?modality=us

https://www.sciencedirect.com/science/article/pii/S2352621115000881#:~:text=Typical
%20ultrasonographic%20findings%20of%20hepatosplenic,lobe%2C%20splenomegaly%2C%20and
%20ascites.
https://www.ajronline.org/doi/full/10.2214/AJR.15.15926

https://www.ajronline.org/doi/full/10.2214/ajr.182.1.1820015

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6473121/

https://www.uptodate.com

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