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52 Cards in this Set
- Front
- Back
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What are 2 major categories of thrombus of the liver
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tumor and bland
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What are the MCC of a tumor thrombus of the liver
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HCC
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What is the MC cause of bland thrombus of the liver
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hypercoaguable state or infectious etiology
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What are some tumors that may cause a tumor thrombus of the liver
3 |
HCC, mets, pancreatic ca.
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What are some causes of a bland thrombus of the liver
7 (hint 3 are infectious and 1 involves a commonly removed organ) |
hypercoaguable state, chronic pancreatitis, septicemia, hepatitis, trauma, splenectomy, portacaval shunts (TIPS)
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Describe a PV thrombus on US
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echogenic, PV expansion, internal vasularity in tumor thrombus
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What is cavernous transformation of the portal vein
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this can occur after a portal thrombus and instead of a single portal vessel there is multiple worm like vessels at the porta
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What are the causes of a fatty liver
8 |
obesity, alcohol abuse, diabetes, steriod therapy, TPN, hyperlipidemia, pregnancy, glycogen storage disease
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What is the differential for diffuse increase in echogeniciy of the liver besides fatty infiltrate
4 |
hemosiderosis, chronic hepatitis, cirrhosis, infiltrating tumor.
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What is the differential for infiltrating tumors that cause diffuse increase in echogenicity of the liver
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HCC, METS (lung, breast, prostate)
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Describe a cirrhotic liver on US
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coarse, heterogenous echotexture (may be echogenic)
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What are suspicisous features of hepatic lesions on US
4 |
hyper/iso echoic halo
solid hypoechoic mass hyperechoic with shadowing multiple solid liver masses |
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What is the ddx for echogenic liver lesions
7 |
focal fat or fatty tumor (lipoma), hemangioma, adenoma, HCC,
mets, FNH (usually isoechoic) |
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What is the usual echotexture of focal nodular hyperplasia
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isoechoic
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Are lipomas of the liver common
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no
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Where are the typical locations of focal fat
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anterior to the PV at the porta
GB fossa Liver margins |
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What are 5 characteristics of a hemangioma appear on US
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echogenic, well defined, homogenous, posterior acoustic enhancement, without demonstratable internal flow.
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Can a hemangioma of the liver be hypoechoic
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yes on a fatty liver
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What are the characteristics of a hemangioma on CT when given contrast
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nodular marginal enhancement with contrast
centripital progression |
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What is the enhancement characteristics of HCC on CT
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arterial phase- greater than the liver
Venous phase- washout and is usually slightly less than the liver but can be isodense |
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What is a characteristic of a small HCC on US
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if less than 5 mm there is a thin hypoechoic halo seen around the tumor
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What is the echotexture of HCC
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Variable: hypo, complex, echogenic
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What percent of pt with HCC have portal venous invasion
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30-60%
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If you see a liver mass what should be evaluated very carefully
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the portal veins bc 30-60% of HCC have portal vein invasion
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What are some US for hepatic mets
6 |
Variable: echogenic, hypoechoic, target, infiltrative, calcified or cystic
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What are the most common findings of a metastatic lesion
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multifocal and heterogeneous
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What are common echogenic metastatic lesion
3 |
GI (adenoCa)
HCC RCC |
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What are some hypoechoic met lesion to the liver
3 |
breast, lung, lymphoma
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What are infiltrative hepatic tumors
4 |
breast
lung melanoma HCC |
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What are lesions that tend to have calcium
4 |
mucinous tumors
osteosarcoma chondrosarcoma neuroblastoma |
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What is a hepatic mets that can be targetoid
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lung
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What is the most common cancer of the liver
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mets is 20 x more common than HCC
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What are the mcc sites of mets to the liver
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GB, colon, stomach, pancrease, breast and lung
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What is hepatoblastoma associated with
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beckman witheman syndrome
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What is the MC primary liver tumor in children
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hepatoblastoma (less than 3)
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Does hepatoblastoma have increased AFP
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yes
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What is the DDX for hypoechoic lesions
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focal fat sparring, simple cyst, abscess, hematoma, bilioma, biliary cystadenoma, atypical hemangioma, neoplasm
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What is the imaging modality of choice for HPS
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US
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What is the position that the baby is in when evaluated for HPS
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the RPO postion
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What should the patient be given prior to looking for HPS
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clear liquids
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What are the measurements that are necessary to diagnose HPS
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single wall thickness of 3 or greater
Pyloric canal length greater than or equal to 15 |
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What is not included when measuring the muscle in HPS
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the echogenic mucosa
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What is a common cause of a false negative result in HPS
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gastric overdistension
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What is a common cause of a false positive result in HPS
2 |
antral under-distension causing the muscle walls to appear falsely thickened and elongated
imaging in a tangential plane can make the muscles appear erroneously thickened |
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What are the 5 ddx of HPS
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pylorospasm
doudenal feeding tubes eosinophilic gastroenteritis antral polyps idiopathic or prostoaglandin-induced foveolar hyperplasia |
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In addition to the muscle what is also thickened in HPS
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the echogenic mucosa
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What is another name for pylorospasm
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antral dyskinesia
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What is pylorospasm (antral dyskinesia)
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persistent elongated and contracted canal
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What differentiates pylorospasm from HPS
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the muscle thickness is less than 3 mm and there is not thickening of the mucosa
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What is another way to differentiate pylorospasm if there is prominent muscles and you want to be sure
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continued observation: the canal opens and fluid passes into the doudenum, however, periods of spasm predominate
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What is a common cause of pylorospasm
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milk allergy or gastritis
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Can pylorospasm become pyloric stenosis
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yes, these pts should be watched because this may progress to pyloric sthensois
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