Liver: Differential Diagnosis







General Imaging Abnormalities




TABLE 93-1

Diffuse Hepatomegaly





















































NEOPLASTIC DISEASES



  • Metastases



  • Hepatoma



  • Lymphoma

INFECTIOUS DISEASES
Viral



  • Hepatitis



  • Mononucleosis



  • AIDS

Bacterial



  • Pyogenic abscess



  • Tuberculosis, miliary



  • Histoplasmosis, miliary



  • Syphilis



  • Pneumocystis infection

Protozoan



  • Amebic abscess



  • Malaria



  • Leptospirosis



  • Trypanosomiasis



  • Kala-azar

Parasitic



  • Echinococcosis



  • Schistosomiasis

Fungal
Candidiasis
DEGENERATIVE DISEASES



  • Cirrhosis



  • Fatty infiltration

ELEVATED VENOUS PRESSURE



  • Congestive heart failure



  • Constrictive pericarditis



  • Tricuspid stenosis



  • Budd-Chiari syndrome

STORAGE DISEASES



  • Steatosis



  • Amyloidosis



  • Hemochromatosis



  • Gaucher’s disease



  • Glycogen storage disease



  • Niemann-Pick disease



  • Histiocytosis



  • Weber-Christian disease



  • Wilson’s disease



  • GM 1 gangliosidosis

MYELOPROLIFERATIVE DISORDERS



  • Myelofibrosis



  • Polycythemia rubra vera



  • Extramedullary hematopoiesis



  • Myeloid metaplasia



  • Thalassemia



  • Sickle cell anemia

CONGENITAL DISORDERS



  • Riedel’s lobe



  • Polycystic disease



  • Wolman’s disease



  • Reye’s syndrome



  • Rubella syndrome



  • Pyruvate kinase deficiency



  • Osteopetrosis



  • Lipoatrophic diabetes



  • Hyperlipoproteinemia



  • Homocystinuria



  • Hepatic fibrosis–renal cystic disease



  • Farber’s syndrome



  • Chédiak-Higashi syndrome



  • Zellweger’s syndrome



  • Beckwith-Wiedemann syndrome



  • Granulomatous disease of childhood

MISCELLANEOUS DISORDERS



  • Sarcoid



  • Hematoma



  • Felty’s syndrome



TABLE 93-2

Hepatomegaly in the Neonate








  • Nutritional disorder



  • Heart failure



  • Infection



  • Biliary atresia



  • Metabolic defect



  • Primary neoplasm



  • Metastases



TABLE 93-3

Focal Hepatic Enlargement











COMMON



  • Anomalous lobes (Riedel)



  • Metastasis



  • Cirrhosis



  • Regenerative nodules or lobes



  • Hemangioma



  • Cysts



  • Adenoma



  • Focal nodular hyperplasia



  • Hepatoma



  • Lymphoma



  • Cholangiocarcinoma

UNCOMMON



  • Hemangioendothelioma



  • Actinomycosis



  • Abscess (fungal or pyogenic)



  • Biliary cystadenoma



  • Hamartoma



  • Hepatoblastoma



  • Sarcoma



  • Spindle cell neoplasm



  • Teratoma



  • Cholangioma



TABLE 93-4

Liver Atrophy with Compensatory Hypertrophy








  • Cirrhosis



  • Hepatic vein obstruction (segmental)



  • Portal vein obstruction (segmental)



  • Intrahepatic biliary obstruction (segmental)



  • Budd-Chiari syndrome



  • Radiation therapy



  • After chemotherapy for hepatic tumor



  • Surgical resection



  • Liver metastases



  • Lobar agenesis



TABLE 93-5

Hepatic Capsular Retraction











ADJACENT TO A HEPATIC TUMOR



  • Primary malignant tumors




    • Hepatocellular carcinoma



    • Fibrolamellar hepatocellular carcinoma



    • Intrahepatic cholangiocarcinoma



    • Epithelioid hemangioendothelioma




  • Metastatic tumors




    • Adenocarcinoma of the colon, stomach, breast, lung, pancreas, and gallbladder




  • Postembolization of hepatocellular carcinoma



  • Postchemotherapy of malignant tumors



  • Benign tumor




    • Hemangioma


WITHOUT AN ADJACENT HEPATIC TUMOR



  • Confluent hepatic fibrosis



  • Oriental cholangiohepatitis



  • Bile duct necrosis



  • Pseudoretraction




    • Accessory fissure



    • Normal liver parenchyma between the protruded masses




TABLE 93-6

Hepatic Calcification



























INFECTIONS



  • Histoplasmosis



  • Tuberculosis



  • Coccidioidomycosis



  • Brucellosis



  • Gumma



  • Echinococcal cyst, Armillifer infestation



  • Chronic amebic or pyogenic abscess



  • Cytomegalovirus or Toxoplasma infection



  • Chronic granulomatous disease of childhood



  • Clonorchis sinensis infection, cysticercosis, filariasis, paragonimiasis

VASCULAR LESIONS



  • Hepatic artery aneurysm



  • Portal vein thrombosis



  • Hematoma

BENIGN TUMORS



  • Cyst



  • Cavernous hemangioma



  • Capsule of regenerative nodules



  • Infantile hemangioendothelioma

PRIMARY MALIGNANT TUMORS



  • Hepatoma, especially fibrolamellar



  • Hepatoblastoma



  • Cholangiocarcinoma

METASTATIC TUMORS



  • Mucinous carcinoma of the colon, breast, or stomach



  • Ovarian carcinoma



  • Melanoma



  • Mesothelioma



  • Osteosarcoma



  • Carcinoid



  • Leiomyosarcoma



  • Teratoma



  • Thyroid carcinoma



  • Chondrosarcoma



  • Neuroblastoma

BILIARY TREE



  • Calculus



  • Cholangiocarcinoma



  • Ascariasis



TABLE 93-7

Neonatal Liver Calcification








  • Calcified venous thrombi (e.g., after umbilical vein catheterization)



  • Hematoma



  • Cytomegalovirus infection



  • Herpesvirus infection



  • Toxoplasmosis



  • Abscess



  • Biliary calcification



  • Hemangioma



  • Hamartoma



  • Hepatoblastoma



  • Hepatocellular carcinoma



  • Metastatic neuroblastoma



  • Ischemic infarct



  • Rubella



TABLE 93-8

Portal Venous Gas








  • Mesenteric infarction



  • Air intravasation during double-contrast barium enema



  • Acute gastric dilation



  • Percutaneous abscess drainage



  • Necrotizing enterocolitis



  • Umbilical vein catheterization



  • Erythroblastosis fetalis



  • Diverticulitis



  • Inflammatory bowel disease



  • Corrosive ingestion



  • Diabetic coma



  • Hemorrhagic pancreatitis



  • Hydrogen peroxide enema



  • Emphysematous cholecystitis



  • Mechanical bowel obstruction with ischemia



  • Necrotic colon cancer



  • Perforation of gastric ulcer into mesenteric vein



  • Abscess



  • Closed-loop obstruction



  • Pseudomembranous colitis



  • Gastric emphysema



  • Toxic megacolon



  • Sepsis



  • Corrosive gastritis



  • Catheterization of umbilical artery or mesenteric vein



  • After hepatic artery embolization



TABLE 93-9

Gas in the Biliary Tract








  • Sphincterotomy



  • Gallstone erosion



  • Patulous sphincter in elderly patient



  • Cholecystoenterostomy



  • Choledochoenterostomy



  • Spontaneous biliary fistula to the colon or duodenum by gallstones



  • Perforating duodenal ulcer



  • Trauma



  • Carcinoma of the gallbladder, colon, stomach, pancreas, duodenum, ampulla, bile duct



  • Diverticulitis



  • Crohn’s disease fistula



  • Emphysematous cholecystitis



  • Cholecystojejunostomy



  • Pancreatitis



  • Strongyloides infection



  • Incompetent sphincter of Oddi



  • Ascariasis lumbricoides infection



  • Clonorchis sinensis infection



  • Ruptured amebic abscess



  • Common duct entry into duodenal diverticulum



  • Metastases



  • Lymphoma



TABLE 93-10

Hepatic Vein Dilation











COMMON



  • Right-sided heart failure



  • Constrictive pericarditis



  • Hepatic venous thrombus



  • Inferior vena cava obstruction or thrombus



  • Tricuspid atresia or stenosis



  • With Valsalva maneuver in normal young patient

UNCOMMON
Right atrial tumor




Ultrasound




TABLE 93-11

Diffusely Increased Hepatic Echogenicity (“Bright Liver”)











COMMON



  • Fatty infiltration



  • Cirrhosis



  • Acute alcoholic hepatitis



  • Severe viral or drug-induced hepatitis



  • Diffuse malignant infiltration



  • Chronic right-sided heart failure



  • AIDS



  • Technical artifact

UNCOMMON



  • Glycogen storage disease



  • Gaucher’s disease



  • Miliary tuberculosis



  • Mononucleosis



  • Portal tract fibrosis



  • Wilson’s disease



  • Lymphoma



  • Sarcoidosis



TABLE 93-12

Focally Increased Hepatic Echogenicity











COMMON



  • Hemangioma



  • Metastases



  • Focal steatosis



  • Adenoma



  • Focal nodular hyperplasia



  • Abscess



  • Hematoma or laceration



  • Hepatocellular carcinoma



  • Fissures

UNCOMMON



  • Cytomegalovirus or Candida infection



  • α 1 -Antitrypsin deficiency



  • Lipoma



  • Angiomyolipoma



  • Infarct



  • Regenerative nodules of cirrhosis



  • Radiation therapy



  • Omentum inserted into bed of hepatic resection



  • Echinococcus multilocularis infection



  • Hemangioendothelioma



TABLE 93-13

Diffusely Decreased Hepatic Echogenicity















COMMON



  • Acute viral hepatitis



  • Schistosomiasis (early)



  • Malignant infiltration

UNCOMMON



  • Leukemia



  • Lymphoma

APPARENT



  • End-stage renal disease



  • Amyloid



  • Nephrocalcinosis



  • Myoglobinuric renal failure



TABLE 93-14

Hepatic Pseudolesions on Ultrasound Studies








  • Diaphragmatic leaflets: peripheral echogenic pseudolesion may simulate mass



  • Falciform ligament: echogenic “mass” (pseudolesion) in left lobe



  • Focal fatty infiltration: echogenic pseudolesion may simulate metastases



  • Focal hepatic sparing in steatosis: hypoechoic pseudolesion often seen in porta



  • Perihepatic fat may invaginate liver, causing hyperechoic masses



  • Ligamentum venosum: fibrous tissue attenuates sound, causing hypoechoic pseudolesion in caudate lobe



  • Gallbladder inflammation: hypoechoic hepatic pseudolesion in adjacent parenchyma

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Jun 23, 2019 | Posted by in GASTROINTESTINAL IMAGING | Comments Off on Liver: Differential Diagnosis

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