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2
Summary
1. Diffuse liver disease
2. Gallbladder and bile duct disorders
3. Renal disorders
4. Abdominal aneurysm
5. Abdominal trauma
Diffuse liver disease
1. Cardiac liver
2. Liver steatosis/dark liver
3. Liver cirrhosis
4. Budd Chiari syndrome
5. Portal vein thrombosis
Cardiac liver
• Aspecific hepatomegaly (‘trop belle image du foie’)
• Pericardial/pleural effusion • Ascites • Dilatation inferior caval vein, loss
respiratory variation• Dilatation hepatic veins (> 1 cm at 2 cm
from the confluence)
Diffuse liver disease
1. Cardiac liver
2. Liver steatosis/dark liver
3. Liver cirrhosis
4. Budd Chiari syndrome
5. Portal vein thrombosis
Global steatosis
• Detecting liver fat• Sensitivity: 60-94%• Specificity: 66-95%
• US CAN NOT DIFFERENTIATE BETWEEN STEATOSIS AND FIBROSIS
Diffuse liver disease
1. Cardiac liver
2. Liver steatosis/dark liver
3. Liver cirrhosis
4. Budd Chiari syndrome
5. Portal vein thrombosis
Liver cirrhosis
• Hepatic signs of liver cirrhosis• Rounded marginal edges• Irregular surface• Dysmorphism • Regeneration nodules • Increased echogenicity (subjective)• Heterogeneous echostructure (subjective)• Retraction hepatic veins, loss triphasic flow pattern
• Extrahepatic signs of liver cirrhosis• Signs of portal hypertension
Cirrhosis US signs: nodularity
• Alterations at liver surface • Low frequency probe (5 MHz): lower liver border • ONLY macronodular cirrhosis/ low sensitivity !!!
• High frequency probe (7.5MHz):• Observation subcutaneous liver border (micronodular
cirrhosis)• Nodularity no exclusive sign of liver cirrhosis• Nodular regenerative hyperplasia• Metastasis• Steatosis
HF probe: diagnosis micronodular cirrhosis
Sensitivity: 91,1% PPV: 93,2%Specificity: 93,5% NPV: 91,5%
Cirrhosis: dysmorfism
• Liver dysmorfism in patients with cirrhosis• Hypertrophy caudate lobe• Different indices possible• CAVE Budd Chiari Syndrome
• Hypotrophy right liver• Hypertrophy left liver
• Pathological mechanism:• Anatomy of caudate lobe (changes in blood supply)
US signs of PHT
• Portal vein changes• Collaterals (umbilical vein, splenic collaterals, epigastric
collaterals)• Ascites• Small amounts: in more dependent positions• Paracolic pouch• Hepatorenal pouch (Morrison)• Douglas pouch
• Gallbladder wall dilatation• Splenomegaly
Umbilical vein
• Recanalization in presence of PHT• Normally obliterated fibrous remnant in ligament teres• Extends from the umbilicus to the left portal vein• From the umbilicus it extends to inferior epigastric veins
communicating with the iliofemoral system• US features:• Hypoechogenic band running in lig teres
Diffuse liver disease
1. Cardiac liver
2. Liver steatosis/dark liver
3. Liver cirrhosis
4. Budd Chiari syndrome
5. Portal vein thrombosis
Budd Chiari Syndrome
• US diagnosis of BCS• Specific signs• Hepatic vein obstruction (acute vs chronic)
• Suggestive signs• Intrahepatic collaterals• Caudate vein > 3mm
• Non-specific signs• Caudate lobe hypertrophy• Inhomogeous parenchyma• Extrahepatic collaterals
Diffuse liver disease
1. Cardiac liver
2. Liver steatosis/dark liver
3. Liver cirrhosis
4. Budd Chiari syndrome
5. Portal vein thrombosis
39
Acute portal vein thrombosis
40
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Chronic portal vein thrombosis
42
Summary
1. Diffuse liver disease
2. Gallbladder and bile duct disorders
3. Renal disorders
4. Abdominal aneurysm
5. Trauma
Acute cholecystitis
• Thickening gallbladder wall
• Oedema gallbladder wall (continuous echo-poor rim around gallbladder or focal echopoor zone in the wall)
• Ultrasonic Murphy’s sign• Pericholecystic fluid• Round shape• Gallstones
Common bile duct: size
• Measurement: proximal portion, just caudal to porta hepatis• Average in adults 4
mm, up to 6 mm is normal
• Increase with age up to 10 mm ??
• Increase after cholecystectomy up to 8-10 mm ??
Bile duct stonesDifficulties• Superposition of duodenum air• Absence of acoustic shadowing • Air in the common bile duct
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Summary
1. Diffuse liver disease
2. Gallbladder and bile duct disorders
3. Renal disorders
4. Abdominal aneurysm
5. Abdominal trauma
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Renal stones
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Hydronephrosis
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Summary
1. Diffuse liver disease
2. Gallbladder and bile duct disorders
3. Renal disorders
4. Abdominal aneurysm
5. Trauma
60
Abdominal aorta aneurysm
Longitudinal Transverse
61
Summary
1. Diffuse liver disease
2. Gallbladder and bile duct disorders
3. Renal disorders
4. Abdominal aneurysm
5. Abdominal trauma
62
Splenic trauma
63
Splenic rupture
64
Renal trauma
65
Liver trauma
66
Subcapsular hematoma