Liver lesions on ultrasonography

1. Liver lesions on USG
Dr Muhammad Qasim Khan
Resident Radiology

2. BEIGN TUMORS

3. MALIGNANT TUMORS

4. DIFFUSE PARENCHYMAL DISEASE

5. CYSTS
• Most common focal liver lesion
• Cysts Display three classic sonographic criteria
1. an anechoic lumen,
2. increased through transmission
3. A well-defined back wall
• Cysts are referred to as complex if they
have internal echoes, a thick wall,
septations that are numerous or thick,
solid elements, or calcification.

8. • Complex cystic lesions are most often due to
hemorrhage.
• Other causes are
 superinfected cyst,
 hematomas,
 abscesses,
 bilomas,
 cystic metastases,
 hemorrhagic or necrotic tumors

9. How to differ b/w cyst and
aneurysms??
• Vascular lesions such as aneurysms,
arterioportal fistulas, and portal hepatic vein
fistulas can simulate cysts.

11. BENIGN TUMORS---HEMANGIOMA
• most common benign liver neoplasm
• more often in women
• The typical appearance is
a homogeneous,
hyperechoic mass that is usually less than 3
cm in size
margins are usually sharp and smooth

14. Benign Tumors…
FOCAL NODULAR HYPERPLASIA
• Tumor of the liver that is composed of
Kupffer cells, hepatocytes, and biliary
structures but lacks the typical normal
lobular hepatic features of portal triads and
central veins.
• Uncommon, it is the second most
frequently encountered benign liver tumor
• More common in women (80% to 90%)

15. • they are not related to birth control pills, although
birth control pills may promote their growth
• On Ultrasound
• The echogenicity of both FNH and its scar is variable,
and it may be difficult to detect on ultrasound.
• Some lesions are
well marginated
others are isoechoic with surrounding liver.
• Detectable lesions characteristically will demonstrate a
central scar with the displacement of peripheral
vasculature on color Doppler examination.
• However, these findings are seen in only 20% of cases .

17. Benign Tumors---Hepatic adenoma
• Generally hormone-induced
• usually solitary
• female predominance related to the use of oral
contraceptives
• obesity and metabolic syndrome are emerging risk
factors
• On Ultrasound
• usually presents as a solitary, well-demarcated,
heterogeneous mass.
• A hypoechoic halo of focal fatty sparing is also
frequently seen.

19. BENIGN LESIONS---BILIARY
HAMARTOMAS
• Rare benign lesions consisting of abundant
fibrocollagenous tissue containing
disorganized bile ducts.
• They are typically less than 5 mm in size
and scattered diffusely throughout the liver.
• ON ULTRASOUND
• Usually solid, nonshadowing, homogeneous,
and either hyperechoic

21. MALIGNANT TUMORS---METASTASES
• The lungs and liver are the most frequent
sites of distant metastatic disease,
• Up to 50% of patients dying of cancer have
liver metastases
• They have a target
appearance with an
echogenic or isoechoic center
and a hypoechoic halo

23. Malignant lesion---Hepatocellular
Carcinoma
• fifth most common malignancy worldwide,
and the third most common cause of cancer-
related death
• 90% of HCC occurs in cirrhotic livers
• Chronic hepatitis C and B, alcohol
• One pattern that is typical of HCC is a
large dominant lesion with scattered
smaller satellite lesions

24. • Tendency to invade the hepatic vasculature
• USG is widely used in screening sensitivity
of approximately 95%

26. Metastatic Tumors---Lymphoma
• On sonography, it usually simulates
metastatic disease, typically appearing as
target lesions or as homogeneous
hypoechoic masses
• Unlike metastatic disease, it is very unusual
for lymphoma to appear hyperechoic, to
contain cystic spaces, or to contain
calcification. Because lymphoma is a very
homo -geneous tumor

27. Lymphoma

28. Infection---Pyogenic Abscess
• Most often a secondary development of
seeding from intestinal sources
• Hepatic abscesses typically appear as complex
fluid collections with a mixed echogenicity, as
thick-walled cystic lesions or as cysts with
fluid–fluid levels
• may mimic solid hepatic masses.
• The presence of through transmission will
often provide a clue to the liquefied nature of
the mass

30. DIFFUSE PARENCHYMAL DISEASE
• Usually results in no detectable
sonographic abnormality. In a limited number
of patients it can cause increased echogenicity
of the portal triads, which appear as small
bright areas on views of the liver
periphery

31. Diffuse parenchymal disease---
Cirrhosis
• Caused by hepatocellular death and
resulting fibrosis and regeneration.
• It occurs most commonly due to alcohol
abuse, which causes micronodular changes
(<1 cm )
• Hepatitis is the most common cause and
results in macronodular cirrhosis (1 -5 cm)

32. • nodularity is a sonographic sign of cirrhosis
• Coarsening and nodularity of the liver
parenchyma are other useful signs of
cirrhosis
• Nodularity and coarsening of the liver
become severe, it can be difficult to detect
focal masses. In such cases MRI should be
considered