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Imaging Indications and Protocols Oral and IV cholangiography have been supplanted by newer cross-sectional imaging and cholescintigraphy. MR hepatobiliary IV contrast agents may be used to supplement CT or MR cholangiography. Cholescintigraphy is a nuclear medicine study used to evaluate the morphology and function of the biliary tree. In a " HIDA scan ," the patient receives an IV administration of Tc-99m iminodiacetic acid compound, an…
KEY FACTS Imaging Multiphasic CT or MR are 1st-line tests Accuracy: Helical CT (~ 80%), MR and PET (~ 90%) Hepatic lymphoma Diffuse low density on CT may mimic steatosis – Easily distinguished from steatosis on MR Multiple well-defined, homogeneous, low-density (CECT) or high-intensity (T2WI) masses Liver metastases Hypovascular metastases: Low-density center with peripheral rim or target-like enhancement Hypervascular metastases: Hyperdense (intense) on arterial-phase CECT or…
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KEY FACTS Terminology Rare, malignant or premalignant, unilocular or multilocular cystic tumor Almost always solitary, in middle-aged women You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here
KEY FACTS You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here
KEY FACTS You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here
KEY FACTS Imaging Patients with chronic liver disease must be in surveillance program Small, curable hepatocellular carcinomas (HCCs) can be diagnosed by CT & MR Criteria for HCC are often specific enough to guide therapy without tissue confirmation Multiphasic contrast-enhanced CT or MR is definitive imaging study Key imaging features Hypervascular mass on arterial phase (CT or MR) with washout on venous & delayed Presence of…
Key Points 1 Cancers of the biliary tract are categorized into four groups: Gallbladder cancer, intrahepatic cholangiocarcinoma, perihilar cholangiocarcinoma, and distal cholangiocarcinoma. 2 Disregarding cases discovered incidentally at cholecystectomy, carcinoma of the gallbladder, because of its late stage of clinical presentation, has an overall 5-year survival rate <20%. 3 Surgical resection that leads to negative margins may be curative for patients with localized cancers limited to…
Key Points 1 Diseases of the bile ducts (BDs) usually manifest with symptoms and signs related to BD obstruction, including pain, jaundice, pruritus, fever, and elevated serum levels of liver biochemical tests. 2 Choledocholithiasis, the most common benign disorder of the biliary tract, may manifest in patients with an intact gallbladder, soon after cholecystectomy, or up to many years after cholecystectomy. Predictors of BD stones in…
Key Points 1 Gallstones are common and generally asymptomatic. 2 Gallstones can result in various clinical sequelae, including biliary pain and acute cholecystitis. 3 Cholecystectomy is the first-line treatment for symptomatic gallstones and acute cholecystitis. 4 In patients who are poor surgical candidates, alternative therapeutic options include percutaneous gallbladder drainage, transpapillary gallbladder drainage, or endoscopic ultrasound (EUS)–guided gallbladder drainage. Cholelithiasis (Gallstones) 1. Gallstone disease is common…
Key Points 1 Liver transplantation (LT) is a life-saving intervention for patients with acute liver failure, end-stage liver disease (ESLD), some inherited and metabolic liver diseases, and a subset of hepatic malignancies such as hepatocellular carcinoma (HCC), cholangiocarcinoma (CC), and neuroendocrine tumors. 2 Advances in surgical techniques, perioperative management, and immunosuppressive regimens have led to improved outcomes in liver transplant recipients. 3 Selection of appropriate candidates…
Key Points 1 Minor liver biochemical test abnormalities are common after surgery; overt liver dysfunction is uncommon but more likely if the patient has preexisting liver disease. 2 Hepatic blood flow is reduced by anesthesia, blood loss, and other hemodynamic derangements. 3 Operative mortality is increased in patients with acute hepatitis, alcoholic hepatitis, severe chronic hepatitis, and Child-Pugh class B and C cirrhosis; additional risk factors…
Key Points 1 Primary bacterial infection of the liver is rare. Systemic infections can cause hepatic derangements, ranging from mild liver biochemical test abnormalities to frank jaundice and, rarely, hepatic failure. 2 Many different spirochetal, protozoal, helminthic, and fungal organisms can involve the liver. 3 Schistosomiasis, capillariasis, toxocariasis, and strongyloidosis evoke strong host inflammatory responses and hepatic fibrosis that contribute to the hepatic manifestations. 4 Leishmaniasis…
Key Points 1 Hepatic abscesses are most commonly pyogenic in Western countries, but amebic abscesses are common in areas of the world where Entamoeba histolytica is endemic. Less frequent causes include fungal and tuberculous abscesses. 2 Diagnosis of hepatic abscess relies on good history taking and simple imaging. 3 The differentiation between amebic and pyogenic hepatic abscess (as well as fungal or tubercular abscess) relies on…
Key Points 1 Hemangioma of the liver is found in up to 20% of the normal population and is rarely of clinical consequence. 2 Other benign tumors of the liver are rare, including hepatic adenoma, which usually requires surgical resection because of the risks of rupture and the possible development of malignancy. 3 In the presence of cirrhosis, hepatocellular carcinoma (HCC) accounts for approximately 75% of…
Key Points 1 Granulomas consist of activated macrophages (epithelioid macrophages) accompanied by T lymphocytes and other immune cells, which infiltrate liver tissue as nodular lesions in reaction to indigestible or foreign antigen or are due to triggering of an untoward immunologic reaction (e.g., drug-induced liver injury [DILI]). 2 The major causes of hepatic granulomas include infectious agents (especially tuberculosis), sarcoidosis, primary biliary cholangitis (PBC), drugs, systemic…
Key Points 1 Approximately 10% of human immunodeficiency virus (HIV)–infected persons worldwide are chronically infected with hepatitis B virus. The choice of antiviral therapy depends on the need for HIV treatment. 2 Approximately 30% of HIV-infected persons are chronically coinfected with hepatitis C virus (HCV). Antiretroviral therapy may improve hepatic outcomes and survival among coinfected patients. Direct-acting antiviral agents (DAAs) have revolutionized HCV therapy to the…
Key Points 1 The clinical presentation, prognosis, and management of several liver disorders can be different in older adults than in younger persons. 2 Hepatic blood flow, liver size, and hepatic regenerative capacity decrease with age; these changes result in decreased metabolism of certain medications and a reduced ability of the liver to recover promptly from diseases such as acute viral hepatitis or drug-induced liver injury…