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Benign liver tumors generally develop on normal or fatty liver, are single or multiple (generally paucilocular), have distinct delineation, with increased echogenity (hemangiomas, benign focal nodular hyperplasia) or absent, with posterior acoustic enhancement effect (cysts), have distinct delineation (hydatid cyst), lack of vascularization or show a characteristic circulatory pattern ...
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 hemangiomas are typically hyperechoic on ultrasound though may occasionally be hypoechoic; ultrasound is not diagnostic. Computed tomography (CT), [3] magnetic resonance imaging (MRI) [4] or single-photon emission computed tomography (SPECT) using autologous labelled Red Blood Cells (RBC) with Tc-99m is diagnostic.
Liver hemangiomas do not usually cause symptoms. [2] [5] They are usually small, with sizes up to 10 centimeters. [5] Their size tends to remain stable overtime. [5] However, if the hemangioma is large it can cause abdominal pain, a sense of fullness in right upper abdominal area, heart problems, and coagulation dysfunction.
During ultrasound examinations, sometimes echogenicity is higher in certain parts of body. Fatty liver could cause increased echogenicity in the liver, especially if the liver transaminases are elevated. [3] Women with polycystic ovary syndrome may also show an increase in stromal echogenicity.
Hepatomegaly is enlargement of the liver. [4] It is a non-specific medical sign, having many causes, which can broadly be broken down into infection, hepatic tumours, and metabolic disorder. Often, hepatomegaly presents as an abdominal mass. Depending on the cause, it may sometimes present along with jaundice. [1]
A periumbilical mass is not always a Sister Mary Joseph nodule. Other conditions that can cause a palpable periumbilical mass include umbilical hernia, infection, and endometriosis. Medical imaging, such as abdominal ultrasound, may be used to distinguish a Sister Mary Joseph nodule from another kind of mass. [2]
Doppler ultrasound of the liver is typically utilized to confirm or suggest the diagnosis. Common findings on liver doppler ultrasound include increased phasicity of portal veins with eventual development of portal flow reversal. The liver is usually enlarged but maintained normal echogenicity. A liver biopsy is required for a definitive diagnosis.