Liver mass echocardiography and ultrasound: Difference between revisions

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Latest revision as of 22:31, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Ultrasound is the initial method of choice for the evaluation of liver mass. On ultrasound, characteristic findings of liver mass, may include: fluid-filled spaces without clear walls, posterior acoustic enhancement, anechoic, hypoechoic, or hyperechoic lesions. The evaluation of liver mass will mainly depend on the echogenicity. Further evaluation with ultrasound should include Doppler examination to determine vascular pattern.

Ultrasound

Ultrasound is the initial method of choice for the evaluation of liver mass. The evaluation of liver mass will mainly depend on echogenicity.^[1]^[2]

On ultrasound, characteristic findings of liver mass may include:
- Fluid-filled spaces without clear walls
- Posterior acoustic enhancement
- Anechoic, hypoechoic, or hyperechoic lesions

Methods

Evaluation with ultrasound should include the following techniques:^[2]

Doppler examination
Contrast-enhanced ultrasound

Type	Ultrasound	Enhanced ultrasound
Benign liver mass	Homogeneous hyperechogenicity Hypoechogenicity with hyperechoic ring Posterior sonic enhancement	Wash out during portal venous phase regardless of arterial vascularity
Malignant liver mass	Hypoechoic halo Target appearance	No wash-out during portal phase
Central scar: large central artery is usually present with spoke-wheel like centrifugal flow Sonographic halo sign: hypoechoic halo sign in liver metastases: used in hepatobiliary imaging, is a concerning feature for malignant lesion if the lesion is a hyperechoic liver lesion

The table below summarizes the characteristic ultrasound findings of common benign and malignant liver masses.


Common liver masses	Ultrasound finding
Ultrasound findings of common liver masses
Hepatic hemangioma	Well-demarcated Homogeneous Hyperechoic mass May be hypoechoic in patients with fatty infiltration
Focal nodular hyperplasia	Detectable lesions Central scar with displacement of peripheral vasculature (Doppler examination)
Hepatic adenoma	Large Right lobe of the liver Central hypoechoic region
Idiopathic noncirrhotic portal hypertension	Isoechoic lesions
Hepatocellular carcinoma	Poorly-defined margins Coarse, irregular internal echoes
Cholangiocarcinoma	Hypo-, iso-, or hyperechoic Homogenous or heterogenous
Metastases	Metastases from adenocarcinoma Multiple and hypoechoic in comparison with the surrounding liver parenchyma

References

↑ Bonder A, Afdhal N (2012). "Evaluation of liver lesions". Clin Liver Dis. 16 (2): 271–83. doi:10.1016/j.cld.2012.03.001. PMID 22541698.
↑ ^2.0 ^2.1 Wilson SR, Jang HJ, Kim TK, Burns PN (2007). "Diagnosis of focal liver masses on ultrasonography: comparison of unenhanced and contrast-enhanced scans". J Ultrasound Med. 26 (6): 775–87, quiz 788–90. PMID 17526609.

[pmid22541698-1] Bonder A, Afdhal N (2012). "Evaluation of liver lesions". Clin Liver Dis. 16 (2): 271–83. doi:10.1016/j.cld.2012.03.001. PMID 22541698.

[pmid17526609-2] 2.0 ^2.1 Wilson SR, Jang HJ, Kim TK, Burns PN (2007). "Diagnosis of focal liver masses on ultrasonography: comparison of unenhanced and contrast-enhanced scans". J Ultrasound Med. 26 (6): 775–87, quiz 788–90. PMID 17526609.

[1]

[2]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Liver mass}}
-{{CMG}} ; {{AE}} {{ADG}}
+{{CMG}}; {{AE}} {{ADG}}
 ==Overview==
-==Echocardiography and ultrasound==
+Ultrasound is the initial method of choice for the evaluation of liver mass. On ultrasound, characteristic findings of liver mass, may include: fluid-filled spaces without clear walls, posterior acoustic enhancement, anechoic, hypoechoic, or hyperechoic lesions.  The evaluation of liver mass will mainly depend on the echogenicity. Further evaluation with ultrasound should include Doppler examination to determine vascular pattern.
+==Ultrasound==
+Ultrasound is the initial method of choice for the evaluation of liver mass. The evaluation of liver mass will mainly depend on echogenicity.<ref name="pmid22541698">{{cite journal |vauthors=Bonder A, Afdhal N |title=Evaluation of liver lesions |journal=Clin Liver Dis |volume=16 |issue=2 |pages=271–83 |year=2012 |pmid=22541698 |doi=10.1016/j.cld.2012.03.001 |url=}}</ref><ref name="pmid17526609">{{cite journal |vauthors=Wilson SR, Jang HJ, Kim TK, Burns PN |title=Diagnosis of focal liver masses on ultrasonography: comparison of unenhanced and contrast-enhanced scans |journal=J Ultrasound Med |volume=26 |issue=6 |pages=775–87; quiz 788–90 |year=2007 |pmid=17526609 |doi= |url=}}</ref>
+*On ultrasound, characteristic findings of liver mass may include:
+**Fluid-filled spaces without clear walls
+**Posterior acoustic enhancement
+**Anechoic, hypoechoic, or hyperechoic lesions
+====Methods====
+:Evaluation with ultrasound should include the following techniques:<ref name="pmid17526609" />
+:*Doppler examination
+:*Contrast-enhanced ultrasound
+{|
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Type
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Ultrasound
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Enhanced ultrasound
+|-
+! align="center" style="background:#DCDCDC;" + |Benign liver mass
+| align="left" style="background:#F5F5F5;" + |
+*Homogeneous hyperechogenicity
+*Hypoechogenicity with hyperechoic ring
+*Posterior sonic enhancement
+| align="left" style="background:#F5F5F5;" + |
+* Wash out during portal venous phase regardless of arterial vascularity
+|-
+! align="center" style="background:#DCDCDC;" + |Malignant liver mass
+| align="left" style="background:#F5F5F5;" + |
+*Hypoechoic halo
+*Target appearance
+| align="left" style="background:#F5F5F5;" + |
+* No wash-out during portal phase
+|-
+| colspan="3" align="left" style="background:#F5F5F5;" + |
+*'''Central scar''':  large central artery is usually present with spoke-wheel like centrifugal flow
+*'''Sonographic halo sign''': hypoechoic halo sign in liver metastases: used in hepatobiliary imaging, is a concerning feature for malignant lesion if the lesion is a hyperechoic liver lesion
+|}
+'''The table below summarizes the characteristic ultrasound findings of common benign and malignant liver masses.'''
+{| style="border: 5px; font-size: 90%; margin: 5px; width: 1000px" align="center"
+! colspan="2" style="padding: 5px 5px; background: #4479BA; font-weight: bold; text-align:center;" |{{fontcolor|#FFF|'''Ultrasound findings of common liver masses'''}}
+| valign="top" |
+|+
+! style="background: #4479BA; width: 300px; text-align:center;" | {{fontcolor|#FFF|'''Common liver masses'''}}
+! style="background: #4479BA; width: 300px; text-align:center;" | {{fontcolor|#FFF|'''Ultrasound finding'''}}
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Hepatic hemangioma
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Well-demarcated
+*Homogeneous
+*Hyperechoic mass
+*May be hypoechoic in patients with fatty infiltration
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Focal nodular hyperplasia
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Detectable lesions
+*Central scar with displacement of peripheral vasculature (Doppler examination)
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Hepatic adenoma
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Large
+*Right lobe of the liver
+*Central hypoechoic region
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Idiopathic noncirrhotic portal hypertension
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Isoechoic lesions
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Hepatocellular carcinoma
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Poorly-defined margins
+*Coarse, irregular internal echoes
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Cholangiocarcinoma
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Hypo-, iso-, or hyperechoic
+*Homogenous or heterogenous
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Metastases
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*Metastases from adenocarcinoma
+:*Multiple and hypoechoic in comparison with the surrounding liver parenchyma
+|}
 ==References==
-{{reflist|2}}
+{{Reflist|2}}
+[[Category:Medicine]]
+[[Category:Gastroenterology]]
+[[Category:Hepatology]]
+[[Category:Oncology]]
+[[Category:Up-To-Date]]
+[[Category:Surgery]]