Hepatobiliary pathologyBy

Dr/ Dina Metwaly

1. Focal lesions Cystic Solid Mixed 2. Diffuse lesions

Hepatic pathology

Hepatic cysts: Congenital lesions but detected late Usually

asymptomatic Isolated or associated with congenital cystic disease Complications [ rupture or hge ] lead to symptoms Few mms to several cms in size Typical cyst criteria 1. Sharply defined margin 2. Paper-thin wall 3. Clear water contents 0-15 HU 4. Absent :Septations , Calcification, Enhancement, Mural

nodules

Cystic lesions of the liver

Hepatic cysts

Frequently occur with no signs of infection

May present with profound septicemia

Microabscesses (less than 2cm) cluster or widely scattered

Macroabscesses :Hypo dense lesion, unilocular or multilocular

Marginal enhancement 6% Gas containing abscesses

uncommon

2. Liver abscess [Pyogenic]

Entameoba Histolytica 10% world widePatients are more often acutely ill Single or multiple near the liver capsule Enhancing wall is evident with peripheral

zone of edema [ Common findings in amebic abscess]

3. Liver abscess [Amebic ]

Larval stage of E. granulosus CT FEATURES TO DIGNOSE HYDATED CYST 1. Other cysts specially in the lung 2. Well defined Unilocular or multilocular cyst

with marginal calcification 3. Internal floating shadows Daughter cysts

within the large cyst

Echinococcal disease [Hydatid cyst]

20% of hepatic tumours The most common benign liver tumour 85% are asymptomatic Female: male = 5:1 50% are multiple Giant hemangioma 6-10 cm in diameter

Benign cystic lesions of the liver Hemangioma

Hemangioma with central area of fibrosis

Hepatic adenoma Focal nodular hyperplasia [ FNH ] Angiomyolipoma Fat containing lesion occurs

in patients with tuberous sclerosis where other lesions are present in the kidney

Benign solid lesions of the liver Rare lesions

8% of all hepatic tumours2nd most common benign

hepatic tumour after hemangioma

80%- 90% in women 3rd – 5th decades

80%- 90% are solitary lesions <5cm in diameter

Central fibrous scar is a characteristic feature

Precontrast CT iso or hypodense lesion

Arterial phase CT Marked enhancement

Focal nodular hyperplasia FNH

The most common primary malignant hepatic neoplasms

3rd – 4th decades male: female 8:1 80% of HCC occur in cirrhotic liver Serum AFP and ultrasound [screening]

Malignant Hepatic LesionsHepatocellular carcinoma

CT findings:1. Single or multiple masses that are hypo

dense to normal liver 2. Calcification may be seen 3. After contrast injection [ better triphasic

study] 4. Arterial phase heterogeneously enhancing

lesion with hypo dense capsule 5. Portal phase hypo dense lesion

The 2nd most common primary malignant tumour

Three types:

1. Intrahepatic tumour arised from small

peripheral ducts

2. Or the major ducts near the helium

3. Or at the bifurcation of the common hepatic

ducts [ Klatskin tumour]

CT

1. Hypo dense lesion that shows heterogenous

enhancement

2. Portal vein invasion is rarely seen

3. Small dilated ducts around the lesion may be

seen

Malignant Hepatic Lesions Cholangiocarcinoma

CholelithiasisEmphysematous CholecystitisPorcelain Gallbladder

Gallbladder diseases

Cholelithiasis is the condition of having gallstones.

This only becomes a problem if the stones cause an inflammation of the gallbladder which is called cholecystitis.

This is often secondary to cystic duct obstruction.

Nuclear medicine and ultrasound are the imaging modalities of choice in the diagnosis of cholelithiasis although 15% of gallstones appear radiopaque on a KUB.

Cholelithiasis

These radiographs were taken as part of an antiquated exam called an oral cholecystogram (OCG). This study clearly demonstrates innumerable radiolucentcholeliths.

Thank you