Lecture 23 Flashcards by Danika Boltz

What are the characteristics of the normal liver on radiographs?

-in the cranial abdomen mostly under the costal arch
-cranial to stomach
-size assessed using the gastric axis

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How is the gastric axis used to assess liver size?

-normal gastric axis is parallel to the ribs
-a large liver will push the stomach caudal and change the gastric axis

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What is shown in these images?

normal liver; normal gastric axis

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What are the characteristics of normal liver on ultrasound?

-smooth, sharp margins
-coarse echotexture
-portal vein walls are hyperechoic
-hypoechoic to the spleen

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What are the characteristics of the biliary tree on ultrasound?

-gall bladder typically contains anechoic bile
-presence of sludge is normal in dogs
-normally do not see intrahepatic bile ducts
-common bile duct is small; normally seen in cats

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What is shown in these images?

normal ultrasound of the liver

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What is shown in these images?

ultrasound of the gall bladder:
-top: anechoic bile
-bottom: sludge (normal in dogs)

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How does generalized liver enlargement differ from focal liver enlargement?

*generalized:
-enlargement of the whole liver with maintenance of normal shape

*focal:
-enlargement of a portion of the liver
-alters liver shape in area of enlargement
-due to a nodule or mass
-can be singular or multiple; focal or multifocal

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What are the differentials for generalized liver enlargement?

*metabolic:
-diabetes mellitus
-hyperadrenocorticism
-hepatic lipidosis

*infectious/inflammatory:
-hepatitis/cholangiohepatitis

*infiltrative neoplasia:
-round cell

*vascular congestion:
-right heart failure
-caval syndrome

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What are the differentials for focal liver enlargement?

*nodular regeneration (most common in dogs)

*neoplasia
-primary or metastatic
-benign or malignant

*abscess/granuloma

*cyst

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What are the radiograph findings in generalized hepatomegaly?

-enlarged liver with maintained shape
-extends beyond costal arch
-displacement of stomach caudally
-rounded margins

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What are the ultrasound findings in generalized hepatomegaly?

-may appear normal aside from size
-diffusely hypo- or hyper-echoic
-may see nodules
-may see distended hepatic veins in cases of congestion

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What is shown in these images?

*generalized hepatomegaly:
-extends past costal arch
-gastric axis no longer parallel with ribs; pylorus pushed caudal

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What can cause generalized hepatomegaly to appear diffusely hyperechoic on ultrasound?

*metabolic/endocrine:
-steroid hepatopathy/hyperadrenocorticism
-endocrine disease/diabetes mellitus
-hepatic lipidosis
-vacuolar hepatopathy

*fibrosis
*chronic hepatitis
*infiltrative disease/round cell neoplasia

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What is shown in this image?

diffusely hyperechoic liver

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What can cause generalized hepatomegaly to appear diffusely hypoechoic on ultrasound?

*acute hepatitis
*congestion
-right heart failure
-caval syndrome

*infiltrative disease/round cell neoplasia

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What is shown in this image?

diffusely hypoechoic liver

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What is shown in these images?

generalized hepatomegaly:
-pendulous abdomen with no fluid accumulation
-likely hyperadrenocorticism/cushing’s

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What is shown in this image?

generalized hepatomegaly

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What is shown in these images?

*generalized hepatomegaly:
-hepatic congestion and ascites
-enlargement of hepatic vein and caudal vena cava

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What are the imaging findings in the event of a liver mass/nodule?

-nodule or mass affecting the liver
-change in shape of liver margins
-possible peritoneal effusion
-mass effect; soft tissue opaque structure displacing the stomach/gastric axis

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How is a hepatic mass differentiated from a splenic mass on radiographs?

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-hepatic masses tend to be cranial to the stomach; exception is a pedunculated liver mass
-may see fat-opaque fascial plane between liver lobe and spleen

What is shown in these images?

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*focal hepatomegaly:
-stomach displaced to the left on VD view
-right kidney is deviated

What is shown in these images?

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Left: normal; normal margin
Middle: diffuse infiltrate; rounded margin
Right: focal mass; enlarged, lumpy margin

What is shown in these images?

hepatic mass

What is shown in this image?

hepatic mass -heterogenous appearance to liver

What is shown in this image?

hepatic mass

What is shown in this image?

isoechoic liver nodule (at indicated markers)

What is shown in this image?

hyperechoic liver nodule (at indicated markers)

What is shown in this image?

hypoechoic liver nodules

What is shown in this image?

cavitated liver mass

What is shown in this image?

numerous liver nodules

What is shown in this image?

targetoid nodule -more likely to be malignant

What is shown in these images?

hepatic abscess -gall bladder would be on the right on a VD view; not seen

What are the characteristics of hepatic cysts/cystadenomas?

-focal or multifocal -cystadenoma is commonly multilocular -well-defined -anechoic, fluid-filled structures -may see distal enhancement

What is shown in these images?

hepatic cysts/cystadenomas

What are the possible etiologies of microhepatia?

-incidental variation -porto-systemic shunt -cirrhosis

What are the imaging findings in microhepatia?

-small liver volume -cranial deviation of stomach/cranial deviation of gastric axis -irregular margins in cases of cirrhosis

What are the ultrasound findings in microhepatia?

-small liver volume (hard to image, GB looks bigger) -irregular margins or nodules if cirrhosis -abnormal vessel if PSS

What is shown in these images?

microhepatia -cranial axis deviated cranially at pylorus

What is shown in these images?

microhepatia

What is shown in these images?

microhepatia -generalized loss of detail -cranial deviation of gastric axis

What is shown in these images?

microhepatia: -abnormal margins due to cirrhosis

What are the characteristics of choleliths?

-mineralized foci in lumen of biliary tree -cholecystoliths in gall bladder -choledocholiths in bile ducts -can be incidental in dogs -can be associated with inflammation/infection -can cause biliary obstruction and rupture

What are the imaging findings in choleliths?

*cholecystoliths: -focal mineral structures in area of gallbladder *choledocholiths: -linear or branching trails of mineral in area of liver

What is shown in these images?

cholecystoliths

What are the ultrasound findings of choleliths?

-defined structure with hyperechoic margin and distal shadow -may see biliary distention in cases of inflammation, infection, or obstruction

What is shown in this image?

choleliths -hyperechoic margin -distal shadow

What are the possible etiologies of biliary distention?

-anorexia/hyporexia/fasting -secondary to pancreatitis -inflammation/infection -gall bladder mucocele -obstruction due to cholelith -obstruction due to mass of the biliary tree, pancreas, or duodenum

What are the imaging findings in biliary distention?

-may see choleliths -may see focal gas in area of gall bladder (emphysematous cholecystitis) -may see peritoneal effusion/peritonitis if ruptured *typically an ultrasound diagnosis

What are the ultrasound findings in biliary distention?

-variable distention of GB or common bile duct -may see intrahepatic bile ducts if distended -may see cause of obstruction -may see thickened, hyperechoic wall in cases of inflammation -gall bladder mucocele characteristic appearance

What is shown in this image?

biliary distention: -wall starting to thicken -sludge present that is starting to mineralize

What are the ultrasound findings in the case of gall bladder mucocele?

-echogenic sediment in the center of the lumen that becomes progressively immobile -surrounded by hypoechoic material -has a stellate or kiwi-fruit appearance when mature -can cause rupture and bile peritonitis

What is shown in these images?

gall bladder mucocele

Lecture 23 Flashcards

(54 cards)