DMS 176 – Metastatic Disease in the Liver, Portal Vein Gas, Pneumobilia and Granulomas

form of malignancy in the liver
Metastatic disease in the liver is the most common _________
GI tract, breast, colon and lung
Metastatic disease in the liver most commonly arises from what organs (in decreasing order)?
varies depending on origin of the malignancy
What is the sonographic appearance of liver metastases?
hypoechoic
What is the most common sonographic appearance of metastatic lesions in the liver?
hypoerechoic or cystic, may contain peripheral halos or calcifications, mixed echogenicity (complex), Target or bull’s eye appearance, *Distortion of liver contour*
What are some examples of sonographic appearances of liver metastases?
elevated ALP, AST and ALT and AFP
What are the lab values associated with liver metastases?
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Air within intrahepatic portal veins
What is portal vein gas?
Ulcerative colitis and Crohn’s disease
What is portal vein gas associated with?
necrotizing enterocolitis
What is the reason for portal vein gas in infants?
ring down/comet tail artifacts, moving bubbles (echogenic foci) that follow the portal vein path
What is the sonographic findings of portal vein gas?
air in the bile ducts
What is pneumobilia?
instrumentation in bile ducts
What is the cause of pneumobilia?
air in portal vein can be seen extending to the periphery of the liver while bile duct air does not
How can pneumobilia be differentiated from portal vein gas?
Histoplasmosis or Tuberculosis infection
What is granulomas caused by?
North America in the Great Lakes Basin and mid-west
What region is granulomas more common in?
spleen
What organ are granulomas most commonly seen in?
small echogenic calcifications in the liver and spleen
What is the sonographic findings of granulomas