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These lesions are well defined, with isoechoic or hypoechoic appearance and sizes less than 1 cm. They are high in numbers and have a more or less uniform distribution, involving all liver segments. They can crowd resulting in large pseudo tumors. At Doppler examination, these nodules have no circulatory signal.
A cavernous liver hemangioma or hepatic hemangioma is a benign tumor of the liver composed of large vascular spaces lined by monolayer hepatic endothelial cells. It is the most common benign liver tumour, and is usually asymptomatic and diagnosed incidentally on radiological imaging or during laparotomy for other intra-abdominal issues.
Currently, if the hepatic adenoma is >5 cm, increasing in size, symptomatic lesions, has molecular markers associated with HCC transformation, rising level of liver tumor markers such as alpha fetoprotein, the patient is a male, or has a glycogen storage disorder, the adenoma is recommended to be surgically removed. [7]
On ultrasound, HCC often appears as a small hypoechoic lesion with poorly defined margins and coarse, irregular internal echoes. When the tumor grows, it can sometimes appear heterogeneous with fibrosis, fatty change, and calcifications. This heterogeneity can look similar to cirrhosis and the surrounding liver parenchyma.
Liver metastasis is the more common of the two liver cancers. [3] Instances of liver cancer are increasing globally. [8] [9] Primary liver cancer is globally the sixth-most frequent cancer and the fourth-leading cause of death from cancer. [7] [10] In 2018, it occurred in 841,000 people and resulted in 782,000 deaths globally. [7]
In the axial plane, the caudate lobe should normally have a cross-section of less than 0.55 of the rest of the liver. [2] Other ultrasound studies have suggested hepatomegaly as being defined as a longitudinal axis > 15.5 cm at the hepatic midline, or > 16.0 cm at the midclavicular line. [17] [18]
The Liver Imaging Reporting and Data System (aka LI-RADS) is a quality assurance tool created and trademarked by the American College of Radiology in 2011 to standardize the reporting and data collection of CT and MR imaging patients at risk for hepatocellular carcinoma (HCC), or primary cancer of the liver cells. [1]
Other patterns include telangiectatic, hyperplastic-adenomatous, and lesions with focal large-cell dysplasia. [4] Rarely, these lesions may be multiple or can occur as part of a syndrome with hemangiomas, epithelioid hemangioendothelioma, hepatic adenomas, fibrolamellar hepatocellular carcinoma, vascular malformations of the brain, meningiomas ...