69 Complex or Solid Liver Masses

CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSIS

EISENBERG

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

• Fig GI 69-1 Hepatoma. Complex mass (arrows) with a large echogenic component.

• Fig GI 69-2 Multinodular hepatocellular carcinoma mimicking metastatic disease. Sagittal scan demonstrates multiple hyperechoic masses.95

• Fig GI 69-3 Metastasis. Sagittal scan shows a large echogenic mass (arrows) with central necrosis. (C, inferior vena cava.)96

• Fig GI 69-4 Multiple metastases. Sagittal scan demonstrates multiple hypoechoic masses (m) in the liver (L). Note the prominent ascitic fluid (A). (K, kidney.)95

• Fig GI 69-5 Diffuse metastases. Transverse scan shows a heterogeneous echo pattern in which areas of hypoechogenicity are mixed with hyperechogenic regions. (L, liver.)95

• Fig GI 69-6 Pyogenic hepatic abscess. Ill-defined complex mass with irregular margins.

• Fig GI 69-7 Hepatic abscess. Large, solid-appearing mass (A) in the right lobe of the liver in a young man with fever and pain in the right upper quadrant.97

• Fig GI 69-8 Candida albicans abscesses. Numerous, rounded, fluid-filled lesions (arrows) with a target appearance.98

Fig GI 69-9 Hemangioma. Transverse sonogram shows a characteristic hyperechoic mass containing homogeneous echoes. (L, liver.)95

• Fig GI 69-10 Echinococcal cyst. (A) Three distinct daughter cysts (arrows) with the typical peripheral location within the mother cyst.99 Hydatid matrix with a solid appearance is seen filling the rest of the cavity. (B) A hydatid cyst in the right lobe of the liver contains wavy bands of delaminated endocyst (water lily sign) (arrows).100

• Fig GI 69-11 Echinococcal multilocularis cyst. Transverse sonogram of the liver shows a typical hailstorm pattern, characterized by multiple echogenic nodules with irregular and indistinct margins.100

• Fig GI 69-12 Schistosomiasis. Longitudinal sonogram through the liver shows the characteristic network pattern, with echogenic septa (arrows) outlining polygonal areas of relatively normal liver parenchyma.100

• Fig GI 69-13 Ascariasis. (A) Sagittal sonogram of the porta hepatic shows a tubular echogenic region (arrow) within the slightly dilated common bile duct (arrowheads). (B) Oblique sonogram in a slightly different plane shows the echogenic region in lengthwise section (open arrow) in the common hepatic and common bile ducts and in cross section (solid arrow) more distally in the common bile duct. The intraluminal abnormality measured approximately 5 mm. The arrowhead denotes the common bile duct.101

• Fig GI 69-14 Focal nodular hyperplasia. The hyperechoic mass (between cursor marks) has a central scar (arrows) and was found in an otherwise normal liver. The middle hepatic vein (v) is displaced.102

• Fig GI 69-15 Hepatic adenoma. Well-defined exophytic right lobe mass (M) containing heterogeneous internal echoes in a young woman taking oral contraceptive pills.102

Fig GI 69-16 Hemangioendothelioma. Sagittal sonogram shows multiple, discrete, hypoechoic solid masses.103

• Fig GI 69-17 Hepatoblastoma. Transverse scan demonstrates the echogenic mass.32

Fig GI 69-18 Fibrolamellar carcinoma. Sonogram shows mixed echogenicity and calcification (curved arrow) within a mass (straight arrow).104

• Fig GI 69-19 Intrahepatic cholangiocarcinoma. Sagittal scan shows a large hyperechoic mass in the right lobe of the liver.105

Fig GI 69-20 Biliary cystadenoma. Multiloculated liver mass. Note that the internal septa show nodular thickening and papillary excrescences.106

• Fig GI 69-21 Focal fatty infiltration. Axial sonogram of the liver shows an ovoid, uniformly hyperechoic focus (arrow) consistent with a localized collection of fat.107

• Fig GI 69-22 Multifocal nodular fatty infiltration. Axial sonogram shows a diffuse pattern of patchy hyperechoic foci (arrow) simulating an infiltrative tumor. The combination of in-phase and opposed-phased MR imaging allows this appearance to be reliably differentiated from metastatic disease.107

• Fig GI 69-23 Lipoma. Axial sonogram shows uniformly hyperechoic lesions (arrow).107