Diagnostic Ultrasound - Abdomen and Pelvis

Periportal Lesion
Helpful Clues for Less Common Diagnoses
• Peribiliary Cyst
○ Well-defined small cystic structures adjacent to portal
triads
○ More common in cirrhotic patients
○ Usually multiple
○ No communication with biliary tree
• HepaticSchistosomiasis
○ Periportal fibrosis
– Most severe at porta hepatis
– Widened portal tracts
– "Clay-pipestem" fibrosis
□ Hyperechoic and thickened walls of portal venules
– Bull's-eye lesion
□ Anechoic portal vein surrounded by echogenic
mantle of fibrous tissue
○ Mosaic pattern
– Network of echogenic septa outlining polygonal areas
of normal-appearing liver
– Represents complete septal fibrosis
□ Inflammation & fibrosis in reaction to embolized
eggs
– May be discontinuous and appear mottled, nodular, or
sieve-like
□ Partial septal fibrosis or calcification
• Recurrent Pyogenic Cholangitis
○ Lateral segment of left lobe and posterior segment of
right lobe more commonly involved
○ Early disease with active biliary sepsis
– Periportal hypo- or hyperechogenicity due to
periductal edema/inflammation
– Biliary duct wall thickening due to edema
– Floating echoes within dilated ducts due to
inflammatory debris
○ Late-stage disease
– Severe atrophy of affected segment/lobe, biliary
cirrhosis
– Crowded stone-filled ducts
□ May appear as single heterogeneous mass
– Stones may form casts of duct
• Iatrogenic Material
○ Shunt, stent, embolization material, drainage tube,
staples, etc.
○ Echogenic material with strong reflective surface or
smooth outline
• Caroli Disease
○ Anechoic masses: Saccular or fusiform shape
○ Central dot sign
– Small portal venous branches partially/completely
surrounded by dilated ducts
• Hepatic Artery Calcification
○ Branching linear echogenic structures along portal triads
○ Often marked calcifications of splenic artery and other
smaller arteries
○ Risk factors
– Longstanding diabetes
– Chronic renal failure
– Conditions that predispose to heavy vascular
calcifications
• Cystic Duct Remnant
○ History of prior cholecystectomy
○ Remnant cystic duct may be dilated
SELECTED REFERENCES
1. Shin SW et al: Usefulness of B-mode and doppler sonography for the
diagnosis of severe acute viral hepatitis A. J Clin Ultrasound. ePub, 2014
2. Spârchez Z et al: Role of contrast enhanced ultrasound in the assessment of
biliary duct disease. Med Ultrason. 16(1):41-7, 2014
3. Trenker C et al: Contrast-enhanced ultrasound (CEUS) in hepatic lymphoma:
retrospective evaluation in 38 cases. Ultraschall Med. 35(2):142-8, 2014
4. Wu S et al: Characteristics suggestive of focal Fatty sparing from liver
malignancy on ultrasound in liver screening. Ultrasound Q. 30(4):276-81,
2014
5. Kobayashi S et al: Intrahepatic periportal high intensity on hepatobiliary
phase images of Gd-EOB-DTPA-enhanced MRI: imaging findings and
prevalence in various hepatobiliary diseases. Jpn J Radiol. 31(1):9-15, 2013
6. Meacock LM et al: Evaluation of gallbladder and biliary duct disease using
microbubble contrast-enhanced ultrasound. Br J Radiol. 83(991):615-27,
2010
7. Passos MC et al: Ultrasound and CT findings in hepatic and pancreatic
parenchyma in acute schistosomiasis. Br J Radiol. 82(979):e145-7, 2009
Differential Diagnoses: Liver
Ascending Cholangitis
Cavernous Transformation of Portal Vein
(Left) Transverse color
Doppler US in a patient with
ascending cholangitis shows
circumferential wall
thickening of the common bile
duct as well as echogenic
debris st within the lumen.
(Right) Color Doppler US
shows collateralized flow ſt
in the porta hepatis in a
patient with chronic portal
vein thrombosis . Color
Doppler signal is
heterogeneous because portal
vein collaterals are tortuous,
resulting in vessels directed
toward as well as away from
the transducer.
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