LIVER DISEASE

[Emmanuel Amakola]

Can you kindly describe the manifestation of Hepatocellular carcinoma (HCC) on ultrasound….if there are also images will appreciate….

[Stephen Bird]

Hi Emmanuel, HCC in the liver can take a variety of appearances on ultrasound. It is a manifestation of cirrhosis or hepatitis and it can present as a well defined solitary solid mass in the liver. It can also be multifocal mimicking metastatic disease and also may present as a diffuse process throughout the liver. Once it is present it can produce venous invasion and you may see tumour thrombus in the portal venous system. Personally I find ultrasound poor in terms of sensitivity, especially when there is background cirrhosis. The problem with cirrhosis is that you have fibrosis of the liver parenchyma and multiple often innumerable regenerating nodules all of which could potentially be a HCC deposit! We use ultrasound for surveillance and if a new nodule appears or the liver texture changes significantly between scans we use CT to clarify the situation. I think the use of serial ultrasound helps to increase our sensitivity as it provides a baseline study and then serial follow up scans. You could consider this similar to regular mammography surveillance for breast cancer screening.

Steve

[Emmanuel Amakola]

In the same line there was a case done whereby the liver was shrunk which massive ascites and in the liver there were multiple masses that were echogenic,small and circumscribed almost oval….what could be your diagnosis on that patient…

[Emmanuel Amakola]

Also the same patient had many other issues,,the GB had 3stones, the kidneys had severe hydronephrosis and enlarged bilaterally and the spleen’s echogenicity was not normal but had normal size

[Stephen Bird]

I bet it had Gamna Gandy bodies.
It gives the spleen an unusual course echo texture and is associated with chronic liver disease.
The primary problem here is progressive liver disease which needs to be managed. The liver disease will eventually progress to portal hypertension and this will have to be managed. A TIPPS shunt may be employed if the liver does not decompress through native pathways. The spleen is nothing we can do anything about although it may enlarge as part of the portal hypertension process.

Steve

[Stephen Bird]

I am considering the description of the small liver with ascites.
When cirrhosis gets to the late stage the liver shrinks and becomes nodular and scarred. Ascites volume rapidly increase especially if the portal vein thromboses or Budd Chiari develops.

I have not seen the images and if you can upload some that would be brilliant.

I am thinking the echogenic areas are fibrosis and may be interspersed with regenerative nodules. HCC would be impossible to exclude on ultrasound I would think.
Multiple focal fatty infiltration areas may also produce this appearance.
Multiple biliary hamartomas is another possibility.
Multiple echogenic metastatic lesions.

I may think of others when I see the images

Steve

[Stephen Bird]

Here is an example of Gamna Gandy bodies.

Steve

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[Stephen Bird]

Here are more examples of Gamna Gandy bodies in the spleen.

Steve

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[Emmanuel Amakola]

Thank you

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