more fixes
Ross
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---
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title: "Cystic Hepatic Mass"
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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"
|
||||
- key: "e987d3d3-1206-48d6-824b-3347c2968855"
|
||||
value: "Michael P. Federle, MD, FACR"
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breadcrumbs:
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-
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name: "Gastrointestinal"
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slug: "gastrointestinal"
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treeNodeId: "992c2a4d-e0c4-4b82-be00-a05f5f19e3be"
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-
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name: "Differential Diagnosis"
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slug: "differential-diagnosis"
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treeNodeId: "b2773887-e8a2-40b6-86b5-3bd2e3ba7c30"
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-
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name: "Liver"
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||||
slug: "liver"
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||||
treeNodeId: "c1682329-7d88-44f2-bd0f-bccf589e5631"
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-
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||||
name: "Generic Imaging Patterns"
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slug: "generic-imaging-patterns"
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||||
treeNodeId: "4f8b9a53-d6d2-4981-ab07-978042118376"
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-
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name: "Cystic Hepatic Mass"
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||||
slug: "cystic-hepatic-mass"
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treeNodeId: null
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||||
category: "Gastrointestinal"
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||||
documentVersionId: "4bcc64c4-b69d-476f-af6c-eee81bea6bd5"
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imageCount: 22
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lastUpdated: "07/29/22"
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pageDescription: "Cystic Hepatic Mass"
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pageKeywords: "Gastrointestinal, Differential Diagnosis, Liver, Generic Imaging Patterns, Cystic Hepatic Mass"
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pageTitle: "Cystic Hepatic Mass | STATdx"
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enhancedTitle: "Cystic Hepatic Mass"
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type: "DDX"
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breadcrumbs:
|
||||
- "Gastrointestinal"
|
||||
- "Differential Diagnosis"
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||||
- "Liver"
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||||
- "Generic Imaging Patterns"
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||||
- "Cystic Hepatic Mass"
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---
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## ESSENTIAL INFORMATION
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- ### Key Differential Diagnosis Issues
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- Any mural nodularity or debris level within cyst should raise concern for tumor, abscess, or hematoma
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- Essential to compare current study with prior studies to observe for interval change
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- Simple cysts change size only slowly
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- Abscesses change quickly
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- Treated tumors may simulate cysts [especially gastrointestinal stromal tumor (GIST)]
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- View images in multiple planes
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- Coronal and sagittal imaging often help to show true morphology, number, and etiology of cystic mass
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- ### Helpful Clues for Common Diagnoses
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- **Hepatic Cyst**
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- Water attenuation, no visible wall
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- No enhancement of cyst contents
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- MR: Very bright on T2, dark on T1 imaging; no enhancement or mural nodularity
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- US: Sonolucent with acoustic enhancement; no visible wall or nodularity
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- Hemorrhage within simple cyst can be difficult to distinguish from cystic neoplasm
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- 1 or 2 thin septa may be seen
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- Often multiple, of varying sizes
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- **Autosomal Dominant Polycystic Disease, Liver**
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- Many cysts of varying sizes
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- Intracyst bleeding results in high-attenuation fluid and calcified cyst walls
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- 2 forms of polycystic liver disease (PLD): Isolated PLD and PLD in association with polycystic kidney disease (PKD)
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- Often results in massive hepatomegaly, but rarely impairs liver function
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- May be associated with cysts in other organs
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- Usually have history of other family members with polycystic disease
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- Cannot diagnose autosomal dominant polycystic liver disease just by presence of numerous hepatic cysts
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- Requires cysts in other organs, family history, or genetic testing
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- **Hepatic Pyogenic Abscess**
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- Multiloculated, multiseptate cluster of complex cysts
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- Wall and septa may show contrast enhancement
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- Associated atelectasis and pleural effusion when abscess occurs in peripheral liver adjacent to diaphragm
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- Etiology
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- Prior surgery or trauma
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- Cholecystitis or cholangitis
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- Hematogenous spread from colon
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- Double target sign: Pus surrounded by pyogenic membrane surrounded by edema
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- **Biliary Hamartomas**
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- Mimic cysts on CT and MR
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- Multiple small (1-1.5 cm), low-attenuation lesions ± echogenic nodules in walls
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- Lack of larger cystic lesions and cysts in other organs distinguishes this from autosomal dominant polycystic disease
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- Should be considered as likely diagnosis in setting of innumerable small, slightly complex "cysts" in healthy patient
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- **Metastases, Hepatic**
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- Most common etiologies
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- From primary cystic tumor (e.g., ovarian)
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- Ovarian primary, sarcomas, GIST, etc. after treatment
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- GIST metastasis treated with Gleevec may mimic simple cyst (check history and prior studies)
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- Squamous cell metastases and mucinous adenocarcinoma mets may appear cystic
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- Most have mural nodularity on CT, US, and MR
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- **Hepatic Amebic Abscess**
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- Solitary, peripheral, round or ovoid mass
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- Endemic in certain populations
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- Imaging appearance, clinical presentation, and serology are diagnostic
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- **Biloma/Seroma**
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- Following trauma, partial liver resection, radiofrequency ablation
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- Uninfected biloma or seroma does not require drainage
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- Often takes weeks to months for large lesions to resolve
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- In setting of liver transplantation, may result from hepatic artery thrombosis with biliary necrosis
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- Biloma in hepatic allograft is ominous finding
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- **Steatosis (Fatty Liver) (Mimic)**
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- Focal deposits may be near-water density on NECT (but echogenic, not cystic, on US)
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- MR also definitive, showing selective signal dropout from focal steatotic areas on opposed-phase GRE imaging
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- ### Helpful Clues for Less Common Diagnoses
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- **Hepatic Candidiasis**
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- Innumerable microabscesses (< 1 cm) with target or wheel appearance
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- Occur in immune-compromised patients
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- Fungal and mycobacterial opportunistic organisms may cause similar appearance
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- **Hepatic Hydatid Cyst**
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- Solitary or multiple
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- Discrete peripheral wall ± calcification
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- Mother cyst contains hydatid matrix/sand, daughter cysts
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- Daughter cysts may be smaller spheres within larger cyst or appear as thick septations
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- **Biliary Cystadenoma/Carcinoma**
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- Asymptomatic until large
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- Solitary, multiseptate mass with discrete enhancing wall and septa
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- Rarely have no visible septa
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- Complete resection of all parts of tumor essential to prevent recurrence
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- Typically in middle-aged women
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- **Biliary Intraductal Papillary Mucinous Neoplasm**
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- Intraductal papillary mucinous neoplasm
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- Analogous to pancreatic intraductal papillary mucinous neoplasm
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- Tumor within bile duct may rarely produce mucin that distends ducts and may simulate cystic mass
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- May see nodular, enhancing component (worrisome for cholangiocarcinoma)
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- **Hepatocellular Carcinoma**
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- Spontaneous necrosis (or following treatment) may simulate cystic mass
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- Usually have solid component with arterial hyperenhancement and delayed washout
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- **Caroli Disease**
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- Cystic dilation of intrahepatic bile ducts
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- Communication with bile ducts is key feature, distinguishing it from other cystic masses
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- Recommend MRCP or ERCP
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- Central dot sign: Dilated ducts surrounding portal vein radicle
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- **Undifferentiated Hepatic Sarcoma**
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- Undifferentiated sarcoma, primary to liver
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- Rare tumor with very aggressive clinical course
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- Typical appearance is large (usually > 10 cm), solitary, encapsulated mass
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- Peripheral hypervascular solid component
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- Often has large complex, cystic spaces with focal hemorrhage
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- Paradoxical appearance: Predominantly solid appearance on US and cystic-like appearance on CT/MR due to high water content of prominent myxoid stroma
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- **Intrahepatic Pseudocyst**
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- May dissect into liver along portal triads
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- Intrahepatic pseudocyst usually has adjacent cyst in pancreatic head
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- Check for imaging and clinical evidence of pancreatitis
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- **Hepatic Inflammatory Pseudotumor**
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- a.k.a. inflammatory myofibroblastic tumor
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- Relatively rare with variable appearance
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- Usually resemble cholangiocarcinoma with delayed, persistent enhancement
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- Rarely has multiseptate, cystic appearance
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- **Ciliated Hepatic Foregut Cyst**
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- Rare congenital anomaly
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- Typically small (< 3 cm), cystic mass in segment IV of liver
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- May appear complex or solid on US
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## Images
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### Selected Images
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**Hepatic Cyst**
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*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.*
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**Hepatic Cyst**
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*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.*
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**Autosomal Dominant Polycystic Disease, Liver**
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*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.*
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**Hepatic Pyogenic Abscess**
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*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.*
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**Biliary Hamartomas**
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*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.*
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**Biliary Hamartomas**
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*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.*
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**Biliary Hamartomas**
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*Coronal MRCP shows innumerable small, T2-hyperintense lesions that do not communicate with the biliary tree.*
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**Metastases, Hepatic**
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*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).*
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**Hepatic Amebic Abscess**
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*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.*
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**Biloma/Seroma**
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*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.*
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**Hepatic Candidiasis**
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*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.*
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**Hepatic Hydatid Cyst**
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*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.*
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**Biliary Cystadenoma/Carcinoma**
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*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.*
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**Biliary Intraductal Papillary Mucinous Neoplasm**
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*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.*
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**Caroli Disease**
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*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'/>.*
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**Undifferentiated Hepatic Sarcoma**
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*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.*
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**Ciliated Hepatic Foregut Cyst**
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*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.*
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### Additional Images
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**Hepatic Cyst**
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*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'/>.*
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**Hepatic Cyst**
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*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'/>.*
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**Biloma/Seroma**
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*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.*
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**Biloma/Seroma**
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*Axial CECT shows dilated bile ducts, peribiliary hepatic fluid, and a cystic biloma in a liver allograft, as a result of hepatic artery thrombosis.*
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**Metastases, Hepatic**
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*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.*
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**Metastases, Hepatic**
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*Axial CECT shows a cystic lesion in the left lobe. This is a metastatic gastric GIST that responded to Gleevec therapy with complete necrosis.*
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@@ -0,0 +1,205 @@
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---
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title: "Focal Liver Lesion With Hemorrhage"
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docid: "5e6be44f-07d3-4569-abe3-798d7513fe41"
|
||||
authors:
|
||||
- key: "6c5a9e0e-9dea-461b-9ad4-c00f5c4c2bbf"
|
||||
value: "Atif Zaheer, MD, FSAR"
|
||||
- key: "e987d3d3-1206-48d6-824b-3347c2968855"
|
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value: "Michael P. Federle, MD, FACR"
|
||||
breadcrumbs:
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-
|
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name: "Gastrointestinal"
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slug: "gastrointestinal"
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treeNodeId: "992c2a4d-e0c4-4b82-be00-a05f5f19e3be"
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name: "Differential Diagnosis"
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slug: "differential-diagnosis"
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treeNodeId: "b2773887-e8a2-40b6-86b5-3bd2e3ba7c30"
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name: "Liver"
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name: "Focal Liver Lesion With Hemorrhage"
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|
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category: "Gastrointestinal"
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imageCount: 23
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lastUpdated: "09/15/22"
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pageDescription: "Focal Liver Lesion With Hemorrhage"
|
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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
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||||
|
||||
- ### Key Differential Diagnosis Issues
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||||
|
||||
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||||
- Hemorrhage may be detected as heterogeneous high attenuation (> 60 HU on NECT), or high-intensity foci on T1WI and T2WI
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- Bleeding may include subcapsular and intraperitoneal extension
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- ### Helpful Clues for Common Diagnoses
|
||||
|
||||
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||||
- **Hepatic Trauma**
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- Blunt or penetrating (including biopsies, TIPS, etc.)
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- Hepatic lacerations usually have linear or stellate configuration
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- Location: Right lobe (75%), left lobe (25%)
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- Best imaging tool: Dual-phase CT in hemodynamically stable patients
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- **Hepatic Adenoma**
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- Foci of hemorrhage within tumor is common feature on MR, less common on CT
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- Spontaneous bleeding within or around hepatic mass in young female without cirrhosis is almost diagnostic of adenoma
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- Other signs of adenoma
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- Lipid or fat content
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- Multiplicity
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- Encapsulation
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- **Hepatocellular Carcinoma**
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- Spontaneous hemorrhage within tumor is uncommon
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- Spontaneous rupture through capsule is relatively common for large hepatocellular carcinoma (HCC)
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- Other signs of HCC
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- Occurrence within cirrhotic liver
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- Hypervascularity with washout
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- Encapsulation
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||||
- **Hepatic Cyst**
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- Isolated or part of autosomal dominant polycystic disease
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- Clotted blood in cyst may be mistaken for tumor but will not show enhancement
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||||
- ### Helpful Clues for Less Common Diagnoses
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||||
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||||
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||||
- **Coagulopathic Hemorrhage, Liver**
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||||
- Spontaneous intrahepatic or perihepatic hemorrhage is rare manifestation of coagulopathy or anticoagulant therapy
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||||
- Spherical hematoma within liver may simulate tumor
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||||
- Others signs of coagulopathic hemorrhage
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- Hematocrit sign (fluid level) within hematoma
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- Multiple sites of bleeding
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- Favored sites: Iliopsoas and rectus muscles
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- **Hepatic Metastases**
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- Hemorrhage is uncommon, usually associated with hypervascular metastases
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- May occur following chemotherapy or transhepatic ablation of metastatic lesions
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||||
- Most commonly: Lung cancer, renal cell carcinoma, pancreatic neuroendocrine tumor, and melanoma
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||||
- **HELLP Syndrome**
|
||||
- Hemolysis, elevated liver enzymes, low platelets
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||||
- Severe variation of toxemia of pregnancy
|
||||
- Intrahepatic or subcapsular fluid collection (hematoma)
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||||
- Occasionally active extravasation
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- Wedge-shaped areas of infarction
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- **Amyloidosis**
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- Hepatocellular rupture extremely rare
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||||
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||||
|
||||
## 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'/>.*
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||||
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||||
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||||
**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'/>.*
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||||
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||||
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||||
**Hepatic Trauma**
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||||
*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'/>.*
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||||
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||||
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||||
**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'/>.*
|
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|
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**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.*
|
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||||
|
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**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.*
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||||
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|
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**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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