7. - THE PROBE IS IN THE EPIGASTRIC REGION JUST BELOW THE STERNUM.
- IT IS ANGLED CEPHALAD TO VIEW THE LEFT LOBE IN ITS ENTIRETY.
- THE PROBE MAY NEED TO BE ANGLED TOWARDS THE LEFT SIDE TO SEE THE
MOST MEDIAL EDGE OF THE LEFT LOBE.
Normal Anatomy seen in the
Transverse View of the Left Lobe.
Transverse View of the Left Lobe
8. • The Liver and Rt Kidney are visualised in this
view.
PARASAGITTAL SCAN PLANE
9. • The probe is angled cephalad under the ribs to avoid any
bowel or ribs shadowing over the liver.
• Rt Portal Vein is shown coursing transversely in this view
SUBCOSTAL SCAN PLANE.
10. • The Middle and Rt Hepatic Vein are visualised in
this view.
INTERCOSTAL SCAN PLANE
12. Anatomic liver segments
caudate lobe Segment I
Lateral segment left lobe
superior
Segment II
Lateral segment left lobe
inferior
Segment III
Medial segment left lobe Segment IV
Anterior segment right
lobe inferior
Segment V
Posterior segment right
lobe inferior
Segment VI
Posterior segment right
lobe superior
Segment
VII
Anterior segment right
lobe superior
Segment
VIII
23. Ultrasound of the left lobe of the liver reveals a mass in the medial segment that
has a hypoechoic "halo" (arrows). The presence of a halo generally indicates
metastatic disease. The lesion proved to be a metastasis from colon cancer.
24. Diffuse infiltration of the liver by metastatic renal cell carcinoma. Transverse
image of the liver shows a heterogeneous echotexture with diffusely increased
echogenicity.
25. Ultrasound of the liver reveals multiple echogenic
masses due to metastatic breast cancer.
26. Echogenic central calcifications, which cast an acoustic shadow (open arrow).
Note the lesion extends into the inferior vena cava (curved arrow). primary
site may from the colon, pancreas, or ovary
50. Periportal tracking. US shows linear hypoechogenicity
(arrows) along the intrahepatic bile ducts.
FASCIOLIASIS
51. • Pathogen: Entamoeba histolytica,
• Anchovy pus
Ultrasonographic finding
–Lesions are round or oval, hypoechoic or anechoic, and have echo-
poor walls.
–Lesions are multiple in 25% of cases and vary in size up to 20 cm.
–Characteristic features are a pattern of fine homogeneous granular
internal echoes and location in the right lobe near the liver capsule.
AMEBIC LIVER ABSCESS
52. This amebic abscess is
much better defined than are
most pyogenic abscesses.
A hypoechoic wall
surrounds the lesion. Internal
contents show hypoechoic
echoes but no internal
vascularity was detected with
Doppler.
AMEBIC LIVER ABSCESS
55. Ultrasonography of the abdomen revealing heterogeneous hypo-echoic
lesions in the right lobe of the liver suggestive of a multiseptate abscess.
TUBERCULOSIS LIVER ABSCESS
59. Diagnosis of fatty liver based on ultrasound evaluation.
1 – parenchymal hyperechogenicity, 2 – intensified attenuation,
3 – poorly visible vessels, 4 – focal hyposteatosis.
Presence of all four signs leads to diagnosis of fatty liver
62. • grade I: increased hepatic echogenicity with visible periportal
and diaphragmatic echogenicity
• grade II: increased hepatic echogenicity with
imperceptible periportal echogenicity, without obscuration
of diaphragm
• grade III: increased hepatic echogenicity with
imperceptible periportal echogenicity and obscuration
of diaphragm
GRADING OF FATTY LIVER
65. • Cirrhosis is the final common pathway of chronic injury to the
liver from many causes.
– Parenchymal necrosis is followed by extensive fibrosis and nodular
regeneration of hepatocytes with progressive distortion of lobar and
vascular architecture
• 3 major pathologic mechanism
1. Cell death
2. Fibrosis
3. Regeneration
• Cause
– alcohol 30-60% (diffused nodular),
– hepatitis 10-30% (postnecrosis) and
– biliary obstruction 10-20% (biliary cirrhosis)
CIRRHOSIS
66. • Morphology of nodular regeneration
1. Micronodular : Ø < 3 mm. Alcoholism
2. Macronodular: Ø > 3 mm. Hepatitis B and C
3. Mixed type: biliary cirrhosis
CIRRHOSIS
67. • Ultrasonographic finding
1. Volume redistribution ในช่วงแรก cirrhosis ตับอำจจะใหญ่ได้ แต่เมื่อเข้ำ
chronic state ขนำดของตับจะเล็กลง แต่ caudate และ left lobe จะมี
ขนำดใหญ่ขึ้น caudate width ต่อ right lobe width (C/RL) > 0.6
2. Coarse echotexture เนื้อตับจะ heterogeneous และ decrease
penetration จำกพังผืด ทำให้ increase echogenicity
3. Regenerating nodules (RN) เกิด regenerating hepatocytes
ล้อมรอบด้วย fibrotic septa Isoechoic or hypoechoic with a
thin echogenic border
4. Dysplastic nodules (DN) or Adenomatoid hyperplastic
nodules Ø > 10 mm. และเป็น Premalignant DN
CIRRHOSIS
68. Female patient with cirrhosis showing "coarsened" echo
texture and enlarged left lobe of liver
CIRRHOSISCIRRHOSIS
69. Advanced cirrhosis. A nodular liver, echogenic in comparison to
renal parenchyma (R)
CIRRHOSISCIRRHOSIS
70. ACUTE VIRAL HEPATITIS
us อำจไม่เห็นควำมผิดปกติ
อำจพบตับโต ผนัง portal vein มี echogenicity เพิ่มขึ้น และ
reduce echogenicity of liver เพรำะมี hepatic
edema เรียกว่ำ starry night liver
Hepatitiswith hypoechoic parenchyma and hyperechoic aspect of the walls
of the portal veins (starrysky appearance) and ascites
71. ACUTE VIRAL HEPATITIS
Hepatitis with hypoechoic parenchyma and hyperechoic aspect of
the walls of the portal veins (starry sky appearance) and ascites
75. • Complicationของacute or chronic congestive heart failure
• Ultrasonographic finding
– Hepatomegaly
– Dilatation of IVC and hepatic vein
CHRONIC PASSIVE CONGESTION
Dilated hepatic veins – Peripheral veins
are broader than 6mm, veins near
influx into inferior vena cava are wider
than 10mm.