Dr muhammad fiaz

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Dr muhammad fiaz

  1. 1. Dr Muhammad FiazMBBS,FRCR (I),MCPS,FCPSAssistant Professor SATHConsultant Musculoskeletal RadiologistAlrazi Healthcare, Lahore
  2. 2. DRMUHAMM AD FIAZ
  3. 3. ULTRASOUND OFHEPATOBLIARY SYSTEM WITH CLINICAL PERSPECTIVE
  4. 4. Liver anatomy
  5. 5. Liver anatomy
  6. 6. Liver Segments
  7. 7. The Liver 1. Size . 2. Texture. 3. Hepatic vasculature . ( portal vein & hepatic veins). 4. Intrahepatic biliary radicles.
  8. 8. Size of Liver:Right lobe : 15 cm.Left lobe: 10 cm.
  9. 9. Size of Liver:
  10. 10. Size of Liver:
  11. 11. The Liver 1. Size . 2. Texture. 3. Hepatic vasculature . ( portal vein & hepatic veins). 4. Intrahepatic biliary radicles.
  12. 12. Texture . Normal .
  13. 13. Texture . Abnormal . Diffuse liver disease. Fatty liver Cirrhosis. Focal liver lesion.
  14. 14. Ultrasonography of the liverFatty liver: Increased echogenicity Liver enlargement. Not always uniform Patchy distribution :specially in the right lobe Focal fat sparing: anterior to GB or PV
  15. 15. Diffuse liver diseaseFatty liver:
  16. 16. Diffuse liver disease Fatty Liver
  17. 17. Diffuse Liver DiseaseLiver cirrhosis:coarse echopattern with: Irregular surface. Coarse texture Isoechoic regeneration of nodules Ascites may present Large caudate lobe
  18. 18. Diffuse Liver Disease
  19. 19. Diffuse Liver Disease
  20. 20. Focal liver lesions Benign Cystic Hemangioma Adenoma Focal nodular Malignant hyperplasia HCC Regeneration Metastasis nodules Lymphoma Cholangiocarci noma
  21. 21. Focal liver lesions Liver cyst Simple Polycystic liver disease Pyogenic abscess Amebic abscess Hydatid cyst.
  22. 22. Focal liver lesions Simple Cysts
  23. 23. Focal liver lesions Abscess
  24. 24. Focal liver lesions Hydatid cyst
  25. 25. Focal liver lesions Hydatid cyst
  26. 26. Focal liver lesions Benign Cystic Hemangioma Adenoma Focal nodular hyperplasia Regeneration nodules
  27. 27. Focal liver lesions Haemangioma
  28. 28. Focal liver lesions Benign Cystic Hemangioma Adenoma Focal nodular hyperplasia Regeneration nodules
  29. 29. Focal liver lesionsAdenoma Iso or hypoechoic Central hypoechoic area Solitary or multiple More in females ( Oral Contraceptive )
  30. 30. Focal liver lesions Adenoma
  31. 31. Focal liver lesions Benign Cystic Hemangioma Adenoma Focal nodular hyperplasia Regeneration nodules
  32. 32. Focal liver lesions Focal nodular hyperplasia Second most common benign focal lesion after haemangioma. Well defined More in the right lobe May have a central scar More in female 20 – 40 years. homogenously isoechoic, but may slightly hyper- or hypoechoic
  33. 33. Focal liver lesions FNH
  34. 34. Focal liver lesions FNH
  35. 35. Focal liver lesions Benign Cystic Hemangioma Adenoma Focal nodular hyperplasia Regeneration nodules
  36. 36. Focal liver lesionsRegeneration Nodules
  37. 37. Focal liver lesions Malignant HCC Metastasis Lymphoma Cholangiocarcinoma
  38. 38. Focal liver lesions
  39. 39. Focal liver lesions
  40. 40. Focal liver lesions Malignant HCC Metastasis Lymphoma Cholangiocarcinoma
  41. 41. Focal liver lesions
  42. 42. Focal liver lesions
  43. 43. Focal liver lesions Malignant HCC Metastasis Lymphoma Cholangiocarcinoma
  44. 44. Focal liver lesions  Klatskin Tumor - Hilar Cholangiocarcinoma  The most common site of biliary adenocarcinoma These tumors are also known as Klatskin tumors. Klatskin tumors have an aggressive biologic behavior.
  45. 45. Focal liver lesions Klatskin tumor
  46. 46. Vascular lesions
  47. 47. Portal Vein
  48. 48. Portal hypertensionPortal vein velocity Normal 20.2 -33.3 cm/sec Cirrhosis 11.0 cm/sec Portal hypertension 15.9 cm/sec
  49. 49. Portal vein
  50. 50. Vascular lesions
  51. 51. QUIZ???
  52. 52. Diffuse Liver DiseaseSchistosomal hepatic fibrosis: (Thickened portal tracts): Portal tracts appear in US as portal vein radicles only. If the wall of these radicles are thickened, we measure the portal tracts (outer-outer diameter). If the diameter is more than 3 mm in more than 3 tracts  “Periportal Thickening”.
  53. 53. QUIZ??
  54. 54. Gall BladderSizeWall thickness.Contents Stone. Mud. Parasites.PolypMass
  55. 55. Gall Bladder Normal
  56. 56. Gall BladderSizeWall thickness.Contents Stone. Mud. Parasites.PolypMass
  57. 57. Gall Bladder Normal
  58. 58. Gall Bladder Inflammation
  59. 59. Gall Bladder Inflammation
  60. 60. Gall BladderSizeWall thickness.Contents Stone. Mud. Parasites.PolypMass
  61. 61. Gall Bladder Stones
  62. 62. Gall Bladder Stones
  63. 63. Gall Bladder Stones
  64. 64. Gall Bladder Stones
  65. 65. Gall Bladder Stones
  66. 66. Gall Bladder Stones
  67. 67. Gall Bladder Mud
  68. 68. Gall Bladder Mud
  69. 69. Gall BladderSizeWall thickness.Contents Stone. Mud. Parasites.PolypMass
  70. 70. Gall Bladder Polyp
  71. 71. Gall Bladder Mass
  72. 72. CBDCBD dilatation if more than 8 mm.IHBRNormally they are not seen.When dilated as in obstructed Jaundice“double barrel sign” (portal vein tributaryand intrahepatic bile radicle).
  73. 73. CBD
  74. 74. CBD
  75. 75. CBD
  76. 76. QUIZ?
  77. 77. Segmental AdenomyomatosisSegmental thickening of wall withhypertrophy of smooth muscles.Rokitansky-Aschoff sinuses may apear ascystic spaces.

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