ULTRASONOGRAPHY



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Retroperiton

 
Goubaa Mohamed MD Djerba Tunisia

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--- Arabic
A right upper quadrant abdominal ultrasound examination is performed on a 40-year-old woman because of vague abdominal discomfort. Pay attention to the liver. Scans 4 and 5 were done 12 months after Scans 1, 2 and 3. And scans 6and 7: three years later. What has happened to the liver in the interim? Chez cette patiente de 40 ans une échographie abdominale a été réalisée pour des douleurs abdominales vagues. Regardez le foie. Les clichés 4 et 5 sont faits 1 an plus tard et les clichés après les premiers clichés 1, 2 et 3. les clichés 6et 7sont faits 3 ans plus tard.

 

 


Liver Fatty steatosis

Fatty Liver


Stéatose foie steatose hépatique

Evolution : After 12 months Evolution : 1 an apres


FOIE STEATOSE SEGMENTAIRE



Evolution : three years later Evolution : 3 ans apres


FATTY LIVER SEGMENTAL


LIVER ULTRASONOGRAPHY
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Cliquez sur les images en bas

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The ultrasound images of the liver show an segmental area of increased echogenicity (abnormal) in segment II, III and IV, sharply demarcated from an area of relatively decreased echogenicity (normal) in segment V, VI, VII, VIII. Additionally, Scan 1 shows clear boundaries between the areas of decreased and increased echogenicity.
Evolution :One year and three years later : The liver echogenicity appears normal. Here, the process is reversible.

Les images échographiques du foie montrent une augmentation segmentaire de l'échgènicité du parenchyme hépatique dans les segments II , III et IV bien délimité d'un secteur de l'échogènicité relativement diminué (foie normal) dans le segment V, VI, VII, VIII. En plus, le 1er cliché montre des limites nettes et rectilignes entre les secteurs de l'échogenicité diminué et accru.
Evolution : Un an et trois ans après: L'aspect du foie redevient normal. Ici, le processus est réversible

 

 

 
Segmental Fatty Liver Disease Stéatose segmentaire du foie

 

Segmental Fatty Liver Disease

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Arabic

 

Fatty change in hepatocytes occurs in patients with diabetes mellitus, obesity, hyperalimentation, transplanted liver, alcohol abuse, and chemical toxicity. Segmental fatty liver is characterized by segmental distribution of fatty infiltration, depending on regional differences in perfusion.

Sonographic Findings :
The fatty replaced liver usually has increased echogenicity with increased attenuation. The liver is difficult to penetrate, and the vascular structures are often difficult to visualize, especially the hepatic veins. Areas of the liver may be spared from fatty infiltration. These fat spared areas appear as localized regions of decreased echogenicity within the more echogenic liver. This fat sparing most often is seen anterior to the gallbladder and the right portal vein or within the left lobe. Fatty infiltration of the liver varies in severity from mild to severe.
Because fat increases the attenuation within liver parenchyma, use of a lower frequency transducer may helpful in the imaging of patient anatomy. Care must be taken to keep in mind the loss of resolution that will accompany a lower frequency transducer. Harmonic imaging if available can be another useful tool in evaluation of the dense liver. The frame rate of the image may become degraded on certain machines with this option.

Etiology of bright liver : Differential
Fatty infiltration.
Cirrhosis.
Acute alcoholic hepatitis.
Severe viral or other hepatitis.
Cardiac failure and venous congestion.
Steroid therapy particularly in conjunction with cytotoxic drugs.
Diffuse infiltration - glycogen storage disease, Gaucher's disease.
Miliary granulomata - tuberculosis.
Extensive malignant infiltration.
Infectious mononucleosis.
Portal tract fibrosis.
Hyperalimentation.
Malnutrition.
Brucellosis.
Fructose intolerance.
Tyrosinaemia. Radiotherapy .
wilson's disease.
Reye's syndrome.

Reference :
1 - Quinn SF, Gosink BB. Characteristic sonographic signs of hepatic fatty infiltration. AJR 1985;145:753-5.
2 - Zwiebel William J. Sonographic diagnosis of diffuse liver disease. Seminars in Ultrasound CT and MRI. Vol. 16, n° 1, PP. 34-48 1995.
3 - Foster KJ, Dewbruy KC, Griffith AH, et al. The accuracy of ultrasound in the detection of fatty infiltration of the liver. Br J Radiol;1980;53:440-2.
4 - Sauerbrei EE, Lopez M. Pesudotumor of the quadrate lobe in hepatic sonography: A sign of generalized fatty infiltration. AJR 1986; 147: 923-7.
5 - White EM, Simeone JF, Muller PR, et al. Focal periportal spring in hepatic pseudomass on US.Radiology 1986, 156: 83- 4.
6 - Rubaltelli L, Savastano S, Cellini L, Zambotti B, Marchioro U. Hyperechoic pseudotumors in segment IV of the liver. J Ultrasound Med. 1997 Sep;16(9):569-72; quiz 573-4.
7 - Laissy JP, Scherrer A, Menu Y, et al. Stéatose hétérogène : Variété échographique ou entité anatomique. Ann Radiol (Paris)1986 ; 29 :56-60.
8 - Pariente EA, Scherrer A, Menu Y, et al. Stéatose hépatique irrégulière. Aspects échographiques et tomodensitométriques. Gastroenterol Clin Biol 1983 ; 7 : 911-4.
9 - Rampal P, Desmorat H, Bruneton JN, et al. Stéatose hépatique irrégulière. Etude clinique et iconographique de 6 cas. Gastroenterol Clin Biol 1986 ;10 : 43-8.
10 - Scott WW, Sanders RC, Seigelman SS. Irregular fatty infiltration of the liver: Diagnosisdilemnas . AJR 1980; 135: 67-71.
11 - Yoshikawa J, Matsui O, Takashima T, et al. Focal fatty change of the falciform ligament: CT and sonographic findings in five surgically confirmed cases AJR 1987; 149: 49.
12 - Marchal G., Tshib W A- BWA-Tumba E., Verbeken E. " SKIP- areas"In hepatic steatosis: a sonographic study.Gastrointest. Radiol. 1986; 11: 151- 157.
13 - Matsuio., Takashima T., Kadoya M. Staininig in liver surrounding gallbladder fossa on hepatic arteriography caused by increased cystic venous drainage. Gastrintest. Radiol. 1987; 12: 307- 312.
14 - Matsuio., Takahashi T., Nishida I. M., Focal spared areas in fatty liver caused by regional decresed portal flow. AJR. 1988 151:300-302.
15 - Paulson E. K., Baker M., Spritzer C., Leder R., Gulliver D. J., Meyers W. Focal fatty infiltration : a cause of montumorous defects in the left hepatic lobe during CT arterial portography . J. comput. Assist. Tomog. 1993; 17: 590- 595.
16 - Battaglia DM, Wanless IR, Brady AP, Mackenzie RL. Intrahepatic sequestered segment of liver presenting as focal fatty change. Am J Gastroenterol. 1995 Dec;90(12):2238-9.
17 - Aubin B, Denys A, Lafortune M, Dery R, Breton G. Focal sparing of liver parenchyma in steatosis: role of the gallbladder and its vessels. J Ultrasound Med. 1995 Feb;14(2):77-80.
18 - Myers RP, Downey D, Chakrabarti S, Marotta PJ. Multiple focal nodular hyperplasia and steatosis: Atypical imaging characteristics. Can J Gastroenterol. 2001 Feb;15(2):137-42.
19 - Pia G, Aresu G, Pascalis L. Detectable hypoechogenic images in diffuse hepatic steatosis: a new ultrasonic finding in the differential diagnosis of expansive lesions of the liver. Minerva Med 1990 Jul-Aug;81(7-8):529-34.
20 - Ward S. C., Metreweli. C. The fatty liver - an uncommon site of metastases , Communications de la Réunion de l' Association Anglaise pour les Ultrasons , 1996, vol . 67, n° 799 .
21 - Maresca G, Barbaro B, Summaria V, De Gaetano AM, Salcuni M, Mirk P, Marano P. Color Doppler ultrasonography in the differential diagnosis of focal hepatic lesions. The SH U 508 A (Levovist) experience. Radiol Med (Torino). 1994 May;87(5 Suppl 1):41-9.
22 - Itai Y, Ohtomo K, Kokubo T, et al . Segmental intensity differences (SID) in the liver on MR images : a sign of intahepatic portal flow stoppage . Radiology 1988 ; 167:17-9.
23 - Bourgeois J M .Un brillant diagnostic échographique : les taches grasses sont luisantes.., Lus Fefrier02, tome5, 1996 , p : 12-13.

 

 

 
 
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