Diagnostic Ultrasound - Abdomen and Pelvis

Diffuse Liver Disease
Differential Diagnoses: Liver
DIFFERENTIAL DIAGNOSIS
Common
• Steatosis (Fatty Liver)
• Cirrhosis
• Acute/Chronic Hepatitis
• Hepatocellular Carcinoma (Diffuse/Infiltrative)
• Infiltrative Metastasis
• Hepatic Lymphoma (Diffuse/Infiltrative)
• Biliary Hamartomas
• Technical Artifact (Mimic)
Less Common
• AIDS
• Hepatic Sarcoidosis
• Amyloidosis
• Schistosomiasis
• Glycogen Storage Disease
• Wilson Disease
• Venoocclusive Disease
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
• Diffusely increased echogenicity: Steatosis and cirrhosis
account for most cases
Helpful Clues for Common Diagnoses
• Steatosis (Fatty Liver)
○ Diffuse increased echogenicity with acoustic attenuation
○ Liver often large with smooth contour
○ With increasing infiltration, vessels are pushed apart and
hepatic veins take more curved course
• Cirrhosis
○ Heterogeneous parenchymal echogenicity
○ Liver surface nodularity, volume shrinkage
○ Altered flow dynamics in hepatic vasculature
• Acute Hepatitis
○ Decreased parenchymal echogenicity due to edema
– Acute alcoholic hepatitis: Increased echogenicity
○ Hepatomegaly, periportal/gallbladder edema, ascites
• ChronicHepatitis
○ Increased and heterogeneous parenchymal echogenicity
• Hepatocellular Carcinoma (Diffuse/Infiltrative)
○ Heterogeneous liver echotexture with refractive
shadows
○ May accompany portal vein tumor thrombosis
• Infiltrative Metastasis
○ Lung or breast primary
○ May simulate cirrhosis
• Hepatic Lymphoma (Diffuse/Infiltrative)
○ Hepatomegaly
○ Numerous small hypoechoic foci, miliary in pattern and
periportal in location
○ May be indistinguishable from normal liver
• Biliary Hamartomas
○ Tiny (< 1.5 cm) echogenic nodules with "comet-tail"
artifacts
○ Numerous tiny lesions lead to inhomogeneous and
coarse liver echotexture
• Technical Artifact (Mimic)
○ Improper transducer or gain setting
Helpful Clues for Less Common Diagnoses
• AIDS
○ Microabscesses from opportunistic infection
(cytomegalovirus, mycobacterium, etc.)
• Hepatic Sarcoidosis
○ Diffuse heterogeneous echo pattern
○ Granulomas seen as hypoechoic nodules
• Schistosomiasis
○ Increased echogenicity caused by diffuse periportal
septal thickening
• Amyloidosis
○ Hepatomegaly
○ Heterogeneous parenchymal echogenicity
SELECTED REFERENCES
1. Heller MT et al: The role of ultrasonography in the evaluation of diffuse liver
disease. Radiol Clin North Am. 52(6):1163-75, 2014
(Left) Transverse abdominal
color Doppler ultrasound
shows diffuse steatosis of the
liver as evidenced by increased
hepatic parenchymal
echogenicity ſt, as well as
marked attenuation of the
ultrasound beam in deeper
portions of the liver resulting
in poor visualization of the
diaphragm . (Right)
Transverse abdominal US in a
patient with cirrhosis shows a
small liver with hepatic
surface nodularity ſt and
heterogeneous parenchymal
echogenicity st. Perihepatic
ascites suggests hepatic
decompensation.
Steatosis (Fatty Liver)
Cirrhosis
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