68 Focal Anechoic (Cystic) Liver Masses

CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSIS

EISENBERG

DR. Muhammad Bin Zulfiqar PGR-FCPS III SIMS/SHL

• Fig GI 68-1 Simple nonparasitic hepatic cyst. Transverse sonogram of the upper abdomen in a patient with suspected metastatic disease and a defect on a radionuclide scan shows a completely sonolucent mass (C) that meets the criteria for a simple uncomplicated cyst. (IVC, inferior vena cava; R, right.)89

• Fig GI 68-2 Polycystic liver disease. (A) Multiple anechoic cysts of various sizes throughout the liver in extensive adult-type polycystic kidney disease. (B) Prone longitudinal sonogram on the same patient shows multiple renal cysts.

• Fig GI 68-3 Caroli's disease. (A) Transverse supine sonogram demonstrates multiple dilated bile ducts (d) as sonolucent spaces in the liver. (S, spine; a, aorta.) (B) Frontal view of a transhepatic cholangiogram in a projection corresponding to that in (A) shows cystic dilatation of the distal intrahepatic ducts (d) with a normal-sized common bile duct (cb).90

• Fig GI 68-4 Traumatic subcapsular hematoma. Transverse scan shows an elliptical fluid collection (F) that developed after blunt trauma to the abdomen.

• Fig GI 68-5 Biloma. Anechoic mass (large arrow) with a few internal echoes and excellent distal sonic enhancement (small arrows) that developed following a gunshot wound to the liver.91

• Fig GI 68-6 Echinococcal cyst. Longitudinal sonogram of the liver shows a well-defined multilocular hypoechoic lesion (cursors) with echogenic internal septa (arrows).92

• Fig GI 68-7 Metastases. Multiple anechoic defects in the liver. (Courtesy of Carol Krebs, Shreveport, LA.)

• Fig GI 68-8 Biliary cystadenoma. (A) Transverse image shows a well-defined anechoic cyst with enhanced through transmission. There are multiple echogenic tumor excrescences extending into the cyst lumen (arrows). (B) In another patient, the complex anechoic cyst contains echogenic septa (straight arrow) and tumor nodules (curved arrow).93

• Fig GI 68-9 Hepatic artery aneurysm. (A) Sagittal sonogram shows the well-circumscribed anechoic aneurysm (A), which has good sound transmission. (B) Arteriogram confirms the aneurysm, which arises from the right hepatic artery.94