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Showing posts with label USG Liver. Show all posts
Showing posts with label USG Liver. Show all posts

Case 101: Hepatic Metastases || Ultrasound

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Clinical Features:

A 35-year-old female patient came with

- H/o breast carcinoma.

- Nonspecific abdominal pain.


Ultrasound Features:

- Multiple irregular heterogeneously hyperechoic vascular space occupying lesions of variable size & shape are noted within the hepatic parenchyma involving almost all the segments.

- Moderate ascites is noted.


Remember:

If any primary source of malignancy is known, then check the hepatic parenchyma carefully during follow up scans to exclude metastasis.


Ultrasound Diagnosis:


Hepatic Metastases 


Ultrasound Images:











Multiple irregular heterogeneously hyperechoic space occupying lesions of variable size & shape are noted within the hepatic parenchyma involving almost all the segments.



Color Doppler shows internal prominent vascularity of hepatic arterial origin




Pelvic region shows moderate ascites


YouTube Link:

For further demonstration, don't forget to check our video:

YouTube Link









Case 97: Hepatic Mild Steatosis with Renal Cortical Bosniak I Cyst || Ultrasound

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Clinical Features:

A 53-year-old female patient


Ultrasound Features:

  • The liver parenchyma is homogeneously echogenic with mild attenuation of the ultrasound beam. 
  • Tiny anechoic well-defined cyst is seen at the left renal interpolar cortex.


Ultrasound Diagnosis:

Hepatic mild steatosis (Grade I)

Left renal interpolar tiny cortical cyst (Bosniak I)


Ultrasound Images:





The liver parenchyma is homogeneously echogenic with mild attenuation of the ultrasound beam. 
H/o cholecystectomy


Tiny anechoic well-defined cyst is seen at the left renal interpolar cortex.


Case 92: Hepatomegaly with Mesenteric Lymphadenopathy || Ultrasound

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Clinical Features:

A 12-year-old male patient with fever & central abdominal pain


Ultrasound Features:

  • The liver is mildly enlarged in size, normal in shape & smooth in contour.
  • Multiple enlarged mesenteric lymph nodes are seen at the paraumbilical region, largest measuring 16mm x 8.5mm. 


Ultrasound Diagnosis:

  • Hepatomegaly
  • Mesenteric lymphadenopathy


Ultrasound Images:




Hepatomegaly


Mesenteric lymphadenopathy at paraumbilical region





Case 91: Hepatomegaly with Moderate Steatosis || Ultrasound

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Clinical Features:

A 60-year-old female patient


Ultrasound Features:

  • The liver is mildly enlarged in size, normal in shape & smooth in contour. 
  • Vertical diameter of the liver in mid-clavicular line is about 15cm. 
  • Parenchyma is homogeneously echogenic with moderate attenuation of the ultrasound beam causing impaired visualization of the intrahepatic vessels and the diaphragm. 
  • No focal lesion is noted. 
  • Hepatic veins are not congested. 
  • Portal vein appears normal in calibre.


Ultrasound Diagnosis:

Hepatomegaly with moderate steatosis (Grade II)


Ultrasound Images:







Hepatomegaly with moderate steatosis (Grade II)



Case 89: Hepatomegaly with Mild Steatosis || Ultrasound

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Clinical Features:

A 52-year-old male patient


Ultrasound Features:

  • The liver is mildly enlarged in size, normal in shape & smooth in contour. 
  • Vertical diameter of the liver in mid-clavicular line is about 16.3cm. 
  • Parenchyma is homogeneously echogenic with mild attenuation of the ultrasound beam. 
  • No focal lesion is noted. 
  • Hepatic veins are not congested. 
  • Portal vein appears normal in calibre.


Ultrasound Diagnosis:

Hepatomegaly with mild steatosis (Grade I)


Ultrasound Images:



Hepatomegaly with mild steatosis (Grade I)




Case 87: Acute Hepatitis || Ultrasound

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Clinical Features:

A 9-year-old girl came with

- Fever

- Nausea & vomiting

- Right upper quadrant pain

- Yellowish discoloration of skin & sclera

- Negative for Dengue


Ultrasound Features:

- Mild Hepatosplenomegaly.

- Diffusely hypoechoic hepatic parenchyma.

- Portal triads appear markedly echogenic against background hypoechoic liver forming the starry sky appearance.

- Thick-walled gallbladder.

- Subcentimetric lymph nodes at porta hepatis.


Remember:

Get accustomed with your machine before telling starry sky appearance.


Ultrasound Diagnosis:

Acute Hepatitis


Ultrasound Images:




Starry sky appearance of the liver


Thickened gallbladder wall


Hepatomegaly


Lymph nodes at the porta-hepatis


Mild splenomegaly


YouTube Link:

For further demonstration, don't forget to check our video:

YouTube Link





Case 79: Mild Fatty Liver (Grade I) & Renal Cortical Cyst (BOSNIAK I)

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Ultrasound Features:

- Hepatic parenchymal echogenicity is homogeneously increased with mild attenuation of the ultrasound beam with well-visualization of intrahepatic vessels & diaphragm. 

- A well-defined small anechoic cystic area with a sharp margin, posterior acoustic enhancement & no internal solid component or septation is noted at the interpolar cortex of the right kidney.


Ultrasound Diagnosis:

- Mild fatty change in the liver (Grade I)

- Right renal cortical cyst (BOSNIAK I)


Ultrasound Images:



Mild fatty change in the liver (Grade I)


Right Renal Cortical Cyst (BOSNIAK I)







Hepatic Segments - Ultrasound

 

Liver is divided into 8 segments:


Segment I: Caudate lobe

Segment II: Left superolateral segment

Segment III: Left inferolateral segment

Segment IV: Medial segment of left lobe/ Quadrate lobe

Segment V: Right anteroinferior segment

Segment VI: Right posteroinferior segment

Segment VII: Right posterosuperior segment

Segment VIII: Right anterosuperior segment


Ultrasound images showing segments:

 










Case 53: Choledocholithiasis || Common Bile Duct Calculus

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Clinical Features:

A 50 years old male patient came with

- Severe right upper abdominal pain.

- Vomiting.


Ultrasound Features:

- Dilated common bile duct.

- A bright echogenic structure casting acoustic shadow is noted within the distal common bile duct lumen.

- Biliary sludge.


Remember:

Other imaging correlation is always safe to exclude distal common bile duct growth when we get a bile duct calculus.


Ultrasound Images:



Fig: Section of gallbladder showing luminal sludge


Fig: Section of gallbladder showing luminal sludge


Fig: Dilated common bile duct (CBD) with distal luminal echogenic calculus

Fig: Dilated common bile duct (CBD) with distal luminal echogenic calculus


Fig: High frequency view; Dilated common bile duct (CBD) with distal luminal echogenic calculus


YouTube Video Link:

https://youtu.be/jA_vi46GUp4








Case 33: Chronic Liver Disease (CLD)

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Chronic Liver Disease (CLD)


Clinical History:

  • 25 years old female with HBV infection

USG Findings:

  • Chronic liver disease (Early changes: mild irregularity & decreasing portal venous flow)
  • Thickened gallbladder wall
  • Gallbladder sludge
  • Mild splenomegaly
  • Splenunculus (Accessory spleen)
  • Displaced IUCD
  • Huge ascites (No bladder seen here)
  • Bilateral pleural effusion (Lt not shown here)



 Fig: Mild hepatic margin irregularity, thickened gallbladder wall with luminal sludge, huge ascites, right sided pleural effusion


Fig: Mild splenomegaly with splenunculus (Accessory spleen)


Fig: Decreasing portal venous flow (Patient on the post-prandial state)


Fig: Displaced IUCD at the lower uterine cavity, huge ascites