1
Q
diffusely echogenic liver on US
A
diffuse hepatic steatosis cirrhosis chronic hepatitis deposition/infiltration of other stuff: - tumor (HCC, mets, lymphoma) - granulomas (TB, sarcoidosis) - amyloid - glycogen storage disease
2
Q
hyperdense liver on CT
A
iron deposition: hemochromatosis, hemosiderosis, oral intake, multiple blood transfusions copper deposition: Wilson disease meds: amiodarone, gold therapy glycogen storage disease previous Thorotrast administration
3
Q
hepatic perivascular low attenuation
A
periportal edema/inflammation: - hepatitis, cholangitis perivascular fat deposition biliary necrosis nutmeg liver: - congestive hepatopathy - Budd-Chiari - hepatic veno-occlusive disease
4
Q
fatty nodule in liver
A
on MRI:
- if lots of small ones: regenerative nodules
- if bigger: adenoma or HCC
on everything else:
- lots of stuff
- often the question is “Are these mets?”
- get an MRI
5
Q
heterogeneous hepatic enhancement
A
vascular - congestive hepatopathy - Budd Chiari/sinusoidal obstruction syndrome - portal venous thrombosis acute hepatitis/fulminant liver failure/hepatic necrosis - viral - autoimmune - hepatotoxins (including meds) deposition - perivascular fat/iron - amyloidosis infiltrative HCC schistosomiasis
6
Q
innumerable hepatic micronodules
A
regenerative nodules/cirrhosis
metastases/lymphoma
sarcoid
fungal/mycobacterial/bartonella infection
7
Q
hypervascular liver metastases
A
MR CT PET melanoma renal cell carcinoma choriocarcinoma thyroid carcinoma pancreatic neuroendocrine tumour (breast, lung)
8
Q
elevated liver stiffness
A
fibrosis/cirrhosis postprandial state in diseased liver acute inflammation extrahepatic cholestasis passive hepatic congestion infiltrative processes
9
Q
lots of hepatic cystic lesions
A
- simple cysts
- biliary hamartomas
- polycystic liver/kidney disease
- peribiliary cysts
- Caroli’s disease
- diffuse cystic metastases
- diffuse (micro)abscesses
- treated tumors (GIST post imatinib, hepatic ablation)
10
Q
1 or a few simple(ish) cystic hepatic lesions
A
- simple cyst
- tumor post ablation, resection or chemo
- pancreatic pseudocyst
- seroma
- biloma
- hepatic foregut duplication cyst
- echinococcal cyst (CL and CE1)
11
Q
1 or a few complex nonenhancing cystic hepatic lesions
A
- hemorrhagic cyst
- hematoma
- biloma
- echinococcal cyst (CE1 or CE5)
12
Q
1 or a few complex enhancing cystic hepatic lesion(s)
A
Tumors: - biliary cystadeno(carcino)ma - cystic mets - cystic HCC - undifferentiated embryonal sarcoma - inflammatory pseudotumor Abscess (pyogenic or amebic) or infected cyst Echinococcal cyst (CE2 to CE4)
13
Q
nutmeg liver
A
Budd-Chiari hepatic veno-occlusive disease congestive hepatopathy - right heart failure - constrictive pericarditis
14
Q
massive caudate lobe hypertrophy
A
Budd-Chiari
primary sclerosing cholangitis
primary biliary cirrhosis
