1. Malignant focal liver lesions

2. Liver is a most common site of metastatic disease
Metastasis
Liver is a most common site of metastatic disease

3. Metastasis Clinical presentation:- Jundice Rt sided pain Hepatomegally
Increase abdominal girth from ascites
Altered liver function tests

4. Metastasis Ultrasound appearance :- If very small can be missed
Solid focal lesion with ill defined margin
May be hypoechoic , hyperechoic , isoechoic or mixed pattern
Mass effect on adjacent structures
Calcifications may be seen
Other features as lobulated outline of the liver , hepatomegally , ascites and lymphadenopathy ( para-aortic , para-caval and portal region ).

5. Metastasis

6. Metastasis
Bull’s eye appearance

7. Metastasis
Notes :-
When searching for liver metastasis , a full scan of the whole abdomen is necessary .
Lymphadenopathy may be difficult to demonstrate on ultrasound

8. Hepatocellular carcinoma
Predisposing factors
Hepatitis
Cirrhosis
Drug related liver diseases

9. Hepatocellular carcinoma
Clinical presentation :-
Small tumors are asymptomatic but causes a raised alpha-fetoprotein

10. Hepatocellular carcinoma
Ultrasound appearance :-
Small lesion in cirrhotic liver can be missed
HCC may be hypoechoic , hyperechoic or mixed echopattern
May be solitary or multiple

11. Hepatocellular carcinoma

12. Hepatocellular carcinoma

13. Diffuse liver diseases

14. Diffuse fatty infiltration of the liver
Caused by accumulation of fat within the hepatic cells
Predisposing factors :-
Alcoholism
Obesity
Diabetes

15. Diffuse fatty infiltration of the liver
Ultrasound appearance :-
The liver appears hyperechoic
As the level of fat deposition increases , the level of echogenicity may reach that of the highly reflective portal tract walls .
The liver appears smooth and homogenous ( ground glass appearance )
The contrast between the liver and RT kidney is increased

16. Diffuse fatty infiltration of the liver
Intrahepatic vessel borders cannot be visualized
Nonvisualization of diaphragm in sever cases

17. Diffuse fatty infiltration of the liver

18. Diffuse fatty infiltration of the liver
Notes :-
Fatty infilteration itself is not usually a significant findings .
Infilteration often occurs in conjunction with other diffuse processes as cirrhosis .
Its increased attenuation reduces the ability of ultrsound to exclude other disease or focal lesions .

19. Cirrhosis
Cirrhosis is defined as hepatic fibrosis with the formation of nodules
Bands of fibrous tissue are laid down in the liver parenchyma between the hepatic lobules leading to distortion of and destruction the normal architecture of the liver separating it into nodules .

20. Cirrhosis
Cirrhosis is not a disease itself but it is a process associated with end stage chronic liver disease
It can result from chronic hepatitis , alcoholic disease
Congenital form :- glycogen storage disease , haemochromatosis and wilson’s disease.

21. Cirrhosis Clinical picture :- Pruritis Fatigue Jaundice Steatorrhea
Raised alkaline phosphatase and serum bilirubin
Signs of portal hypertension

22. Cirrhosis Ultrasound picture
at first hepatomegally then average size then shrunken
increased echogenicity, coarse, heterogenous
Nodular surface
Regenerating nodules: hypoechoic
Unequal distribution of cirrhosis in different segments

23. Cirrhosis Portal hypertension
* Collaterals: left gastric, paraesophageal, gastric , porta hepatis,
splenorenal and gall bladder wall
* Splenomegaly
Ascites

24. Cirrhosis Complications
Hepatocellular carcinoma (HCC) occurs in 10% of patients with cirrhosis;
Esophageal varices with bleeding

25. Cirrhosis

26. Cirrhosis

27. Thank you