more fixes
This commit is contained in:
Ross
@@ -506,5 +506,12 @@
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}
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@@ -6864,5 +6864,201 @@
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---
|
||||
title: "Cystic Hepatic Mass"
|
||||
docid: "85bb9a0b-2d25-457d-a131-20ff07cb552b"
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||||
authors:
|
||||
- key: "6c5a9e0e-9dea-461b-9ad4-c00f5c4c2bbf"
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value: "Atif Zaheer, MD, FSAR"
|
||||
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value: "Michael P. Federle, MD, FACR"
|
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|
||||
name: "Cystic Hepatic Mass"
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slug: "cystic-hepatic-mass"
|
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category: "Gastrointestinal"
|
||||
documentVersionId: "4bcc64c4-b69d-476f-af6c-eee81bea6bd5"
|
||||
imageCount: 22
|
||||
lastUpdated: "07/29/22"
|
||||
pageDescription: "Cystic Hepatic Mass"
|
||||
pageKeywords: "Gastrointestinal, Differential Diagnosis, Liver, Generic Imaging Patterns, Cystic Hepatic Mass"
|
||||
pageTitle: "Cystic Hepatic Mass | STATdx"
|
||||
enhancedTitle: "Cystic Hepatic Mass"
|
||||
type: "DDX"
|
||||
breadcrumbs:
|
||||
- "Gastrointestinal"
|
||||
- "Differential Diagnosis"
|
||||
- "Liver"
|
||||
- "Generic Imaging Patterns"
|
||||
- "Cystic Hepatic Mass"
|
||||
---
|
||||
## ESSENTIAL INFORMATION
|
||||
|
||||
- ### Key Differential Diagnosis Issues
|
||||
|
||||
|
||||
- Any mural nodularity or debris level within cyst should raise concern for tumor, abscess, or hematoma
|
||||
- Essential to compare current study with prior studies to observe for interval change
|
||||
- Simple cysts change size only slowly
|
||||
- Abscesses change quickly
|
||||
- Treated tumors may simulate cysts [especially gastrointestinal stromal tumor (GIST)]
|
||||
- View images in multiple planes
|
||||
- Coronal and sagittal imaging often help to show true morphology, number, and etiology of cystic mass
|
||||
- ### Helpful Clues for Common Diagnoses
|
||||
|
||||
|
||||
- **Hepatic Cyst**
|
||||
- Water attenuation, no visible wall
|
||||
- No enhancement of cyst contents
|
||||
- MR: Very bright on T2, dark on T1 imaging; no enhancement or mural nodularity
|
||||
- US: Sonolucent with acoustic enhancement; no visible wall or nodularity
|
||||
- Hemorrhage within simple cyst can be difficult to distinguish from cystic neoplasm
|
||||
- 1 or 2 thin septa may be seen
|
||||
- Often multiple, of varying sizes
|
||||
- **Autosomal Dominant Polycystic Disease, Liver**
|
||||
- Many cysts of varying sizes
|
||||
- Intracyst bleeding results in high-attenuation fluid and calcified cyst walls
|
||||
- 2 forms of polycystic liver disease (PLD): Isolated PLD and PLD in association with polycystic kidney disease (PKD)
|
||||
- Often results in massive hepatomegaly, but rarely impairs liver function
|
||||
- May be associated with cysts in other organs
|
||||
- Usually have history of other family members with polycystic disease
|
||||
- Cannot diagnose autosomal dominant polycystic liver disease just by presence of numerous hepatic cysts
|
||||
- Requires cysts in other organs, family history, or genetic testing
|
||||
- **Hepatic Pyogenic Abscess**
|
||||
- Multiloculated, multiseptate cluster of complex cysts
|
||||
- Wall and septa may show contrast enhancement
|
||||
- Associated atelectasis and pleural effusion when abscess occurs in peripheral liver adjacent to diaphragm
|
||||
- Etiology
|
||||
- Prior surgery or trauma
|
||||
- Cholecystitis or cholangitis
|
||||
- Hematogenous spread from colon
|
||||
- Double target sign: Pus surrounded by pyogenic membrane surrounded by edema
|
||||
- **Biliary Hamartomas**
|
||||
- Mimic cysts on CT and MR
|
||||
- Multiple small (1-1.5 cm), low-attenuation lesions ± echogenic nodules in walls
|
||||
- Lack of larger cystic lesions and cysts in other organs distinguishes this from autosomal dominant polycystic disease
|
||||
- Should be considered as likely diagnosis in setting of innumerable small, slightly complex "cysts" in healthy patient
|
||||
- **Metastases, Hepatic**
|
||||
- Most common etiologies
|
||||
- From primary cystic tumor (e.g., ovarian)
|
||||
- Ovarian primary, sarcomas, GIST, etc. after treatment
|
||||
- GIST metastasis treated with Gleevec may mimic simple cyst (check history and prior studies)
|
||||
- Squamous cell metastases and mucinous adenocarcinoma mets may appear cystic
|
||||
- Most have mural nodularity on CT, US, and MR
|
||||
- **Hepatic Amebic Abscess**
|
||||
- Solitary, peripheral, round or ovoid mass
|
||||
- Endemic in certain populations
|
||||
- Imaging appearance, clinical presentation, and serology are diagnostic
|
||||
- **Biloma/Seroma**
|
||||
- Following trauma, partial liver resection, radiofrequency ablation
|
||||
- Uninfected biloma or seroma does not require drainage
|
||||
- Often takes weeks to months for large lesions to resolve
|
||||
- In setting of liver transplantation, may result from hepatic artery thrombosis with biliary necrosis
|
||||
- Biloma in hepatic allograft is ominous finding
|
||||
- **Steatosis (Fatty Liver) (Mimic)**
|
||||
- Focal deposits may be near-water density on NECT (but echogenic, not cystic, on US)
|
||||
- MR also definitive, showing selective signal dropout from focal steatotic areas on opposed-phase GRE imaging
|
||||
- ### Helpful Clues for Less Common Diagnoses
|
||||
|
||||
|
||||
- **Hepatic Candidiasis**
|
||||
- Innumerable microabscesses (< 1 cm) with target or wheel appearance
|
||||
- Occur in immune-compromised patients
|
||||
- Fungal and mycobacterial opportunistic organisms may cause similar appearance
|
||||
- **Hepatic Hydatid Cyst**
|
||||
- Solitary or multiple
|
||||
- Discrete peripheral wall ± calcification
|
||||
- Mother cyst contains hydatid matrix/sand, daughter cysts
|
||||
- Daughter cysts may be smaller spheres within larger cyst or appear as thick septations
|
||||
- **Biliary Cystadenoma/Carcinoma**
|
||||
- Asymptomatic until large
|
||||
- Solitary, multiseptate mass with discrete enhancing wall and septa
|
||||
- Rarely have no visible septa
|
||||
- Complete resection of all parts of tumor essential to prevent recurrence
|
||||
- Typically in middle-aged women
|
||||
- **Biliary Intraductal Papillary Mucinous Neoplasm**
|
||||
- Intraductal papillary mucinous neoplasm
|
||||
- Analogous to pancreatic intraductal papillary mucinous neoplasm
|
||||
- Tumor within bile duct may rarely produce mucin that distends ducts and may simulate cystic mass
|
||||
- May see nodular, enhancing component (worrisome for cholangiocarcinoma)
|
||||
- **Hepatocellular Carcinoma**
|
||||
- Spontaneous necrosis (or following treatment) may simulate cystic mass
|
||||
- Usually have solid component with arterial hyperenhancement and delayed washout
|
||||
- **Caroli Disease**
|
||||
- Cystic dilation of intrahepatic bile ducts
|
||||
- Communication with bile ducts is key feature, distinguishing it from other cystic masses
|
||||
- Recommend MRCP or ERCP
|
||||
- Central dot sign: Dilated ducts surrounding portal vein radicle
|
||||
- **Undifferentiated Hepatic Sarcoma**
|
||||
- Undifferentiated sarcoma, primary to liver
|
||||
- Rare tumor with very aggressive clinical course
|
||||
- Typical appearance is large (usually > 10 cm), solitary, encapsulated mass
|
||||
- Peripheral hypervascular solid component
|
||||
- Often has large complex, cystic spaces with focal hemorrhage
|
||||
- Paradoxical appearance: Predominantly solid appearance on US and cystic-like appearance on CT/MR due to high water content of prominent myxoid stroma
|
||||
- **Intrahepatic Pseudocyst**
|
||||
- May dissect into liver along portal triads
|
||||
- Intrahepatic pseudocyst usually has adjacent cyst in pancreatic head
|
||||
- Check for imaging and clinical evidence of pancreatitis
|
||||
- **Hepatic Inflammatory Pseudotumor**
|
||||
- a.k.a. inflammatory myofibroblastic tumor
|
||||
- Relatively rare with variable appearance
|
||||
- Usually resemble cholangiocarcinoma with delayed, persistent enhancement
|
||||
- Rarely has multiseptate, cystic appearance
|
||||
- **Ciliated Hepatic Foregut Cyst**
|
||||
- Rare congenital anomaly
|
||||
- Typically small (< 3 cm), cystic mass in segment IV of liver
|
||||
- May appear complex or solid on US
|
||||
|
||||
|
||||
## Images
|
||||
|
||||
|
||||
### Selected Images
|
||||
|
||||
|
||||
**Hepatic Cyst**
|
||||
*Axial CECT in a 79-year-old woman shows a spherical liver mass <img src='img/arrows/WS.png' alt='white solid arrow'/> with water density, homogeneous contents. No internal debris or wall irregularities are present.*
|
||||
|
||||
|
||||
**Hepatic Cyst**
|
||||
*Axial CECT in a 79-year-old woman shows a spherical liver mass <img src='img/arrows/WS.png' alt='white solid arrow'/> with water density, homogeneous contents. No internal debris or wall irregularities are present.*
|
||||
|
||||
|
||||
**Autosomal Dominant Polycystic Disease, Liver**
|
||||
*Axial CECT shows innumerable hepatic cysts of water attenuation and varying size, causing hepatomegaly. Only a few small renal cysts are present, and renal function is normal.*
|
||||
|
||||
|
||||
**Hepatic Pyogenic Abscess**
|
||||
*Axial CECT shows a liver mass with innumerable septa and slightly higher than water density contents <img src='img/arrows/WS.png' alt='white solid arrow'/>. Needle aspiration yielded a small quantity of pus, and a catheter was inserted for drainage. The etiology was subacute diverticulitis.*
|
||||
|
||||
|
||||
**Biliary Hamartomas**
|
||||
*Axial CECT in a 53-year-old man shows innumerable small, cystic lesions <img src='img/arrows/WS.png' alt='white solid arrow'/> throughout the liver, ranging in size from 2-15 mm. The lesions are often not perfectly spherical, and many have visible nodular enhancement within their walls.*
|
||||
|
||||
|
||||
**Biliary Hamartomas**
|
||||
*US shows only the lesions > 10 mm as cystic structures <img src='img/arrows/WS.png' alt='white solid arrow'/>, while the smaller lesions are hyperechoic <img src='img/arrows/WC.png' alt='white curved arrow'/> to background liver. All are typical features of biliary hamartomas.*
|
||||
|
||||
|
||||
**Biliary Hamartomas**
|
||||
*Coronal MRCP shows innumerable small, T2-hyperintense lesions that do not communicate with the biliary tree.*
|
||||
|
||||
|
||||
**Metastases, Hepatic**
|
||||
*Axial CECT shows several hypodense hepatic masses, including 1 cystic lesion <img src='img/arrows/WO.png' alt='white open arrow'/>. The subtle mural nodule <img src='img/arrows/BS.png' alt='black solid arrow'/> is the clue that this is a neoplasm (metastatic thyroid cancer).*
|
||||
|
||||
|
||||
**Hepatic Amebic Abscess**
|
||||
*Axial CECT shows a shaggy, encapsulated, solitary cystic mass <img src='img/arrows/WS.png' alt='white solid arrow'/> with nonenhancing contents, representing a typical amebic abscess. The imaging appearance, clinical presentation, and serology usually suffice for diagnosis.*
|
||||
|
||||
|
||||
**Biloma/Seroma**
|
||||
*Axial CECT 3 weeks after a blunt traumatic liver laceration shows a lobulated, cystic lesion <img src='img/arrows/WS.png' alt='white solid arrow'/> that represents a combination of walled-off bile and blood, also known, respectively, as biloma and seroma. Clinical history and comparison with prior CT scans provide confident diagnosis.*
|
||||
|
||||
|
||||
**Hepatic Candidiasis**
|
||||
*Axial CECT in a febrile, immune-suppressed patient shows innumerable small, hypodense lesions in the liver with irregular walls. Other opportunistic hepatic infections may have a similar appearance.*
|
||||
|
||||
|
||||
**Hepatic Hydatid Cyst**
|
||||
*Coronal CECT in immigrant from Middle East shows 2 large, multiseptate, cystic masses <img src='img/arrows/WS.png' alt='white solid arrow'/>. Within outer pericyst are multiple daughter cysts or scolices. Imaging appearance, coupled with serology, is usually sufficient for diagnosis.*
|
||||
|
||||
|
||||
**Biliary Cystadenoma/Carcinoma**
|
||||
*Coronal CECT in a middle-aged woman shows complex, cystic mass, lobulated margins, enhancing wall and septa <img src='img/arrows/WS.png' alt='white solid arrow'/>. These findings with no other known tumor could be considered sufficiently diagnostic of biliary cystadenoma to warrant resection without further evaluation.*
|
||||
|
||||
|
||||
**Biliary Intraductal Papillary Mucinous Neoplasm**
|
||||
*Axial CECT of biliary IPMN with cholangiocarcinoma shows dilated intrahepatic bile ducts and a cystic mass <img src='img/arrows/WO.png' alt='white open arrow'/>. ERCP showed opacification of the cyst with contrast and the presence of surface nodularity within the bile ducts.*
|
||||
|
||||
|
||||
**Caroli Disease**
|
||||
*Axial CECT in a woman with portal hypertension due to congenital hepatic fibrosis and Caroli disease shows splenomegaly, varices <img src='img/arrows/CC.png' alt='cyan curved arrow'/>, and multiple hepatic cysts. These represent dilated intrahepatic bile ducts, draped around the central dot of accompanying portal veins <img src='img/arrows/CS.png' alt='cyan solid arrow'/>.*
|
||||
|
||||
|
||||
**Undifferentiated Hepatic Sarcoma**
|
||||
*Coronal CECT in a man with RUQ pain shows a huge, multiseptate, cystic mass <img src='img/arrows/WS.png' alt='white solid arrow'/> with enhancing peripheral components. Intraperitoneal blood <img src='img/arrows/WC.png' alt='white curved arrow'/> was due to capsular rupture of this undifferentiated primary hepatic sarcoma.*
|
||||
|
||||
|
||||
**Ciliated Hepatic Foregut Cyst**
|
||||
*Axial T2 MR in a 29-year-old woman with a solid-appearing mass on US shows a complex, cystic-appearing mass in segment 4 that had no enhancement on other sequences. Resection proved ciliated hepatic foregut cyst.*
|
||||
|
||||
|
||||
### Additional Images
|
||||
|
||||
|
||||
**Hepatic Cyst**
|
||||
*Axial CECT shows an unusually large, simple hepatic cyst that caused compression and obstruction of the intrahepatic bile ducts <img src='img/arrows/WS.png' alt='white solid arrow'/>.*
|
||||
|
||||
|
||||
**Hepatic Cyst**
|
||||
*Axial T2 FS MR shows several large, contiguous hepatic cysts. Hemorrhage within the cysts accounts for decreased signal intensity within portions of the cysts <img src='img/arrows/WS.png' alt='white solid arrow'/>.*
|
||||
|
||||
|
||||
**Biloma/Seroma**
|
||||
*Axial CECT shows an irregular cystic lesion within a transplanted liver. This is a biloma with biliary necrosis as a result of hepatic artery thrombosis.*
|
||||
|
||||
|
||||
**Biloma/Seroma**
|
||||
*Axial CECT shows dilated bile ducts, peribiliary hepatic fluid, and a cystic biloma in a liver allograft, as a result of hepatic artery thrombosis.*
|
||||
|
||||
|
||||
**Metastases, Hepatic**
|
||||
*Axial CECT shows a heterogeneous, solid mass in the left lobe (that subsequently underwent cystic necrosis with treatment). This was found to be metastatic gastric GIST.*
|
||||
|
||||
|
||||
**Metastases, Hepatic**
|
||||
*Axial CECT shows a cystic lesion in the left lobe. This is a metastatic gastric GIST that responded to Gleevec therapy with complete necrosis.*
|
||||
|
||||
+205
@@ -0,0 +1,205 @@
|
||||
---
|
||||
title: "Focal Liver Lesion With Hemorrhage"
|
||||
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|
||||
imageCount: 23
|
||||
lastUpdated: "09/15/22"
|
||||
pageDescription: "Focal Liver Lesion With Hemorrhage"
|
||||
pageKeywords: "Gastrointestinal, Differential Diagnosis, Liver, Generic Imaging Patterns, Focal Liver Lesion With Hemorrhage"
|
||||
pageTitle: "Focal Liver Lesion With Hemorrhage | STATdx"
|
||||
enhancedTitle: "Focal Liver Lesion With Hemorrhage"
|
||||
type: "DDX"
|
||||
breadcrumbs:
|
||||
- "Gastrointestinal"
|
||||
- "Differential Diagnosis"
|
||||
- "Liver"
|
||||
- "Generic Imaging Patterns"
|
||||
- "Focal Liver Lesion With Hemorrhage"
|
||||
---
|
||||
## ESSENTIAL INFORMATION
|
||||
|
||||
- ### Key Differential Diagnosis Issues
|
||||
|
||||
|
||||
- Hemorrhage may be detected as heterogeneous high attenuation (> 60 HU on NECT), or high-intensity foci on T1WI and T2WI
|
||||
- Bleeding may include subcapsular and intraperitoneal extension
|
||||
- ### Helpful Clues for Common Diagnoses
|
||||
|
||||
|
||||
- **Hepatic Trauma**
|
||||
- Blunt or penetrating (including biopsies, TIPS, etc.)
|
||||
- Hepatic lacerations usually have linear or stellate configuration
|
||||
- Location: Right lobe (75%), left lobe (25%)
|
||||
- Best imaging tool: Dual-phase CT in hemodynamically stable patients
|
||||
- **Hepatic Adenoma**
|
||||
- Foci of hemorrhage within tumor is common feature on MR, less common on CT
|
||||
- Spontaneous bleeding within or around hepatic mass in young female without cirrhosis is almost diagnostic of adenoma
|
||||
- Other signs of adenoma
|
||||
- Lipid or fat content
|
||||
- Multiplicity
|
||||
- Encapsulation
|
||||
- **Hepatocellular Carcinoma**
|
||||
- Spontaneous hemorrhage within tumor is uncommon
|
||||
- Spontaneous rupture through capsule is relatively common for large hepatocellular carcinoma (HCC)
|
||||
- Other signs of HCC
|
||||
- Occurrence within cirrhotic liver
|
||||
- Hypervascularity with washout
|
||||
- Encapsulation
|
||||
- **Hepatic Cyst**
|
||||
- Isolated or part of autosomal dominant polycystic disease
|
||||
- Clotted blood in cyst may be mistaken for tumor but will not show enhancement
|
||||
- ### Helpful Clues for Less Common Diagnoses
|
||||
|
||||
|
||||
- **Coagulopathic Hemorrhage, Liver**
|
||||
- Spontaneous intrahepatic or perihepatic hemorrhage is rare manifestation of coagulopathy or anticoagulant therapy
|
||||
- Spherical hematoma within liver may simulate tumor
|
||||
- Others signs of coagulopathic hemorrhage
|
||||
- Hematocrit sign (fluid level) within hematoma
|
||||
- Multiple sites of bleeding
|
||||
- Favored sites: Iliopsoas and rectus muscles
|
||||
- **Hepatic Metastases**
|
||||
- Hemorrhage is uncommon, usually associated with hypervascular metastases
|
||||
- May occur following chemotherapy or transhepatic ablation of metastatic lesions
|
||||
- Most commonly: Lung cancer, renal cell carcinoma, pancreatic neuroendocrine tumor, and melanoma
|
||||
- **HELLP Syndrome**
|
||||
- Hemolysis, elevated liver enzymes, low platelets
|
||||
- Severe variation of toxemia of pregnancy
|
||||
- Intrahepatic or subcapsular fluid collection (hematoma)
|
||||
- Occasionally active extravasation
|
||||
- Wedge-shaped areas of infarction
|
||||
- **Amyloidosis**
|
||||
- Hepatocellular rupture extremely rare
|
||||
|
||||
|
||||
## Images
|
||||
|
||||
|
||||
### Selected Images
|
||||
|
||||
|
||||
**Hepatic Trauma**
|
||||
*Axial CECT in a trauma victim shows a broad hepatic laceration <img src='img/arrows/WS.png' alt='white solid arrow'/> with foci of active bleeding <img src='img/arrows/WC.png' alt='white curved arrow'/> and hemoperitoneum <img src='img/arrows/CS.png' alt='cyan solid arrow'/>. Note adjacent rib fractures <img src='img/arrows/CC.png' alt='cyan curved arrow'/>.*
|
||||
|
||||
|
||||
**Hepatic Trauma**
|
||||
*Axial CECT in a trauma victim shows a broad hepatic laceration <img src='img/arrows/WS.png' alt='white solid arrow'/> with foci of active bleeding <img src='img/arrows/WC.png' alt='white curved arrow'/> and hemoperitoneum <img src='img/arrows/CS.png' alt='cyan solid arrow'/>. Note adjacent rib fractures <img src='img/arrows/CC.png' alt='cyan curved arrow'/>.*
|
||||
|
||||
|
||||
**Hepatic Trauma**
|
||||
*Axial NECT in a patient with a falling hematocrit following liver biopsy shows high-density blood in a linear tract deep within the liver <img src='img/arrows/WS.png' alt='white solid arrow'/>, representing the biopsy site and depth. Also note the extension as a subcapsular hematoma, the lentiform collection lateral to the liver <img src='img/arrows/WC.png' alt='white curved arrow'/>.*
|
||||
|
||||
|
||||
**Hepatic Adenoma**
|
||||
*Axial CECT in a young woman shows a hypervascular mass <img src='img/arrows/WS.png' alt='white solid arrow'/> in the right lobe with a large, spontaneous subcapsular hematoma <img src='img/arrows/CC.png' alt='cyan curved arrow'/>.*
|
||||
|
||||
|
||||
**Hepatic Adenoma**
|
||||
*Axial NECT in a young woman with acute pain shows a mass <img src='img/arrows/WS.png' alt='white solid arrow'/> in the lateral segment with high-attenuation material <img src='img/arrows/WC.png' alt='white curved arrow'/> centrally due to an acute hematoma.*
|
||||
|
||||
|
||||
**Hepatic Adenoma**
|
||||
*Axial T1 MR in a young woman shows a hepatic mass <img src='img/arrows/WS.png' alt='white solid arrow'/> containing several hyperintense foci <img src='img/arrows/WC.png' alt='white curved arrow'/> that represent hemorrhage. The foci were hyperintense on T2 as well, distinguishing hemorrhage from fat as the etiology.*
|
||||
|
||||
|
||||
**Hepatocellular Carcinoma**
|
||||
*Arterial-phase CECT in a man with cirrhosis and sudden right upper quadrant (RUQ) pain shows tumor vessels within a poorly defined, hypervascular mass <img src='img/arrows/WS.png' alt='white solid arrow'/>. Ascites and a sentinel clot <img src='img/arrows/CC.png' alt='cyan curved arrow'/> overlying the hepatic mass are seen. Spontaneous rupture of hepatocellular carcinoma was the etiology.*
|
||||
|
||||
|
||||
**Hepatocellular Carcinoma**
|
||||
*Arterial-phase CECT in the same patient shows part of the hypervascular mass <img src='img/arrows/WS.png' alt='white solid arrow'/>, as well as the ascites and sentinel clot <img src='img/arrows/WC.png' alt='white curved arrow'/> overlying the site of the capsular rupture. A catheter angiogram confirmed bleeding hepatocellular carcinoma. It was treated with coil embolization.*
|
||||
|
||||
|
||||
**Hepatocellular Carcinoma**
|
||||
*Axial NECT in a 60-year-old man with alcoholic liver disease and sudden RUQ pain shows a hyperdense sentinel clot <img src='img/arrows/WC.png' alt='white curved arrow'/> within and around the liver as well as a spherical hepatic mass <img src='img/arrows/WS.png' alt='white solid arrow'/>.*
|
||||
|
||||
|
||||
**Hepatocellular Carcinoma**
|
||||
*Coronal CECT in a woman with cirrhosis and sudden RUQ pain shows a heterogeneous, encapsulated mass <img src='img/arrows/WS.png' alt='white solid arrow'/> that was hyperdense on arterial phase. There is generalized ascites but also a sentinel clot <img src='img/arrows/WC.png' alt='white curved arrow'/> over the mass, indicating the source of bleeding.*
|
||||
|
||||
|
||||
**Hepatic Cyst**
|
||||
*Axial CECT shows a large mass with a thin wall, characteristic of a simple cyst. Within the cyst is a heterogeneous focus of higher attenuation <img src='img/arrows/WO.png' alt='white open arrow'/>, suggestive of acute hemorrhage. Other sections showed hemorrhagic ascites.*
|
||||
|
||||
|
||||
**Hepatic Cyst**
|
||||
*Grayscale ultrasound shows a hepatic cyst <img src='img/arrows/WS.png' alt='white solid arrow'/> containing a heterogeneous organizing hematoma with fibrin strands <img src='img/arrows/WO.png' alt='white open arrow'/>.*
|
||||
|
||||
|
||||
**Hepatic Cyst**
|
||||
*Axial FS T2 MR shows a large, complex cystic mass with dependent settling of material <img src='img/arrows/BS.png' alt='black solid arrow'/> that is hypointense on T2, indicating subacute hemorrhage.*
|
||||
|
||||
|
||||
**Autosomal Dominant Polycystic Disease, Liver**
|
||||
*Axial T1 GRE opposed-phase MR shows many cysts within an enlarged liver. Many of the cysts are of water intensity <img src='img/arrows/WO.png' alt='white open arrow'/> (dark on this T1), while others <img src='img/arrows/WS.png' alt='white solid arrow'/> are bright, due to hemorrhage.*
|
||||
|
||||
|
||||
**Coagulopathic Hemorrhage, Liver**
|
||||
*Axial CECT shows signs of coagulopathic hemorrhage, including the hematocrit sign <img src='img/arrows/BO.png' alt='black open arrow'/>, active bleeding <img src='img/arrows/BC.png' alt='black curved arrow'/>, and multiple sites of bleeding, including hepatic <img src='img/arrows/BS.png' alt='black solid arrow'/> and renal <img src='img/arrows/WS.png' alt='white solid arrow'/>.*
|
||||
|
||||
|
||||
**Coagulopathic Hemorrhage, Liver**
|
||||
*Axial CECT in a patient who was taking anticoagulant medication shows hepatic defects that resemble fracture planes <img src='img/arrows/BS.png' alt='black solid arrow'/>, but there was no history of trauma. A subcapsular hematoma <img src='img/arrows/WO.png' alt='white open arrow'/> and hemoperitoneum are also shown. All findings resolved with withdrawal of the medication. No underlying hepatic mass or other pathology was found.*
|
||||
|
||||
|
||||
**Hepatic Metastases**
|
||||
*Axial CECT shows a large metastatic lesion in the liver <img src='img/arrows/WS.png' alt='white solid arrow'/> from a pancreatic neuroendocrine tumor with a subcapsular hematoma <img src='img/arrows/WC.png' alt='white curved arrow'/> from spontaneous bleeding.*
|
||||
|
||||
|
||||
**Hepatic Metastases**
|
||||
*Axial CECT in a 55-year-old man with melanoma shows metastasis to the liver <img src='img/arrows/WS.png' alt='white solid arrow'/> that is peculiarly heterogeneous and high density, perhaps indicating bleeding within the metastasis.*
|
||||
|
||||
|
||||
**Hepatic Metastases**
|
||||
*Axial CECT in a patient with metastatic melanoma and acute RUQ pain shows a hepatic mass <img src='img/arrows/WS.png' alt='white solid arrow'/>. Immediately adjacent to this metastasis is a heterogeneous sentinel clot <img src='img/arrows/WC.png' alt='white curved arrow'/>, strongly suggesting bleeding from the metastases. Also noted is an extensive hemoperitoneum <img src='img/arrows/WO.png' alt='white open arrow'/> with an attenuation of 35 HU.*
|
||||
|
||||
|
||||
**HELLP Syndrome**
|
||||
*Axial CECT in a young woman with toxemia and sudden RUQ pain shows a massive subcapsular and perihepatic hematoma <img src='img/arrows/WC.png' alt='white curved arrow'/>, along with active bleeding <img src='img/arrows/WS.png' alt='white solid arrow'/> and heterogeneous enhancement of the hepatic parenchyma <img src='img/arrows/WO.png' alt='white open arrow'/>.*
|
||||
|
||||
|
||||
**HELLP Syndrome**
|
||||
*Axial CECT in a postpartum woman with RUQ pain shows a large, subcapsular hematoma <img src='img/arrows/WC.png' alt='white curved arrow'/> and hepatic infarcts <img src='img/arrows/WS.png' alt='white solid arrow'/>.*
|
||||
|
||||
|
||||
### Additional Images
|
||||
|
||||
|
||||
**Hepatic Trauma**
|
||||
*Axial NECT shows a deep linear focus of hyperdensity <img src='img/arrows/WS.png' alt='white solid arrow'/> and a subcapsular collection of similar appearance. The hematoma was due to a percutaneous liver biopsy.*
|
||||
|
||||
|
||||
**Hepatic Adenoma**
|
||||
*Axial T1 FS MR shows peripheral foci of hyperintensity <img src='img/arrows/BS.png' alt='black solid arrow'/> on T1 that remained hyperintense on T2, indicating hemorrhage. This was hepatic adenoma.*
|
||||
|
||||
|
||||
**HELLP Syndrome**
|
||||
*In this woman with HELLP syndrome and spontaneous bleeding, a selective hepatic arteriogram indirectly shows the subcapsular hematoma <img src='img/arrows/BC.png' alt='black curved arrow'/> as the liver is displaced medially. It also shows multiple foci of active hemorrhage <img src='img/arrows/BS.png' alt='black solid arrow'/>, which were treated with coil embolization.*
|
||||
|
||||
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Reference in New Issue
Block a user