Ebook Gastrointestinal imaging: Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Gastrointestinal imaging: Part 2
Ebook Gastrointestinal imaging: Part 2
Section VIIIFocal Liver DiseaseCHAPTER 60Cystic Hepatic TumorsJin-Young Choi, Guilhcrmo Moura da Cunha. Beatriz c. Baranski Kantak, and Claude B. Sirl Ebook Gastrointestinal imaging: Part 2linA. Simple Hepatic Cysts and Polycystic Liver Diseasewell-defined cysts arc present, usually in both lobes of the liver. These cysts are histologically identical to hepatic cysts and their pathogenesis is thought to he similar.DefinitionSimple hepatic cysts are benign developmental epithelium line Ebook Gastrointestinal imaging: Part 2d lesions that contain serous fluid and do not communicate with the biliary system. Autosomal dominant polycystic liverdiseaseisaninheriteddisorderchaEbook Gastrointestinal imaging: Part 2
racterized by cyst formation in several organs, including the liver.Demographic and Clinical FeaturesSimple hepatic cysts are present in at least 2.5%Section VIIIFocal Liver DiseaseCHAPTER 60Cystic Hepatic TumorsJin-Young Choi, Guilhcrmo Moura da Cunha. Beatriz c. Baranski Kantak, and Claude B. Sirl Ebook Gastrointestinal imaging: Part 2c: rarely symptoms may arise owing to compression of bile ducts or other adjacent structures.Most hepatic cysts are sporadic, but can also occur in association with autosomal dominant (AD) polycystic hepatorenal disease. About 40% of patients with AD polycystic hepatorenal disease with renal involve Ebook Gastrointestinal imaging: Part 2ment have hepatic cysts; 15% of a flee ted patients have multiple hepatic cysts but no radiographically identifiable renal cysts. AD polycystic-liverEbook Gastrointestinal imaging: Part 2
disease is usually asymptomatic. Rarely advanced disease manifests with painful hepatomegaly, abdominal protuberance and discomfort, hepatic dysfunctiSection VIIIFocal Liver DiseaseCHAPTER 60Cystic Hepatic TumorsJin-Young Choi, Guilhcrmo Moura da Cunha. Beatriz c. Baranski Kantak, and Claude B. Sirl Ebook Gastrointestinal imaging: Part 2d-Chiari syndrome.PathologyHistologically, hepatic cysts arc lined with a single layer of cuboidal epithelium, identical to that of bile ducts, and a thin rim of fibrous stroma. Although the pathogenesis of hepatic cysts is not known, it is believed that they are congenilal/dcvclopmcntal in origin, Ebook Gastrointestinal imaging: Part 2resulting from progressive dilation of biliary microhamartomas that failed to develop normal connections with the biliary tree. AD polycystic liver diEbook Gastrointestinal imaging: Part 2
sease is part of the libropolycystic liver disease spectrum, which includes bile duct hamartoma, Caroli disease, and congenital hepatic bfibrosis. TheSection VIIIFocal Liver DiseaseCHAPTER 60Cystic Hepatic TumorsJin-Young Choi, Guilhcrmo Moura da Cunha. Beatriz c. Baranski Kantak, and Claude B. Sirl Ebook Gastrointestinal imaging: Part 2ing modalities, cysts are sharply marginated, round or ovoid in shape, contain simple appearing fluid, and show no or only a few thin (equal to or less than 2 mm) septations. The presence of multiple, thick (equal to or greater than 3 mm), irregular, or nodular septations or internal debris suggests Ebook Gastrointestinal imaging: Part 2 a neoplastic or infectious process and warrants a more aggressive workup.On ultrasound, cysts are sonolucent with posterior acoustic enhancement andEbook Gastrointestinal imaging: Part 2
imperceptible walls (Figure 60-1). At unenhanced CT. cysts are homogeneously hypoattenuating; after intravenous administration of contrast, the cyst wSection VIIIFocal Liver DiseaseCHAPTER 60Cystic Hepatic TumorsJin-Young Choi, Guilhcrmo Moura da Cunha. Beatriz c. Baranski Kantak, and Claude B. Sirl Ebook Gastrointestinal imaging: Part 2intense (“light bulb” appearance) on T'2-weighted images (Figure 60-3). I leavily T2-weighled images accentuate the apparent hyperintensity of the cyst relative to the surrounding liver. Owing to 1'2 shine through, cysts may be mildly hyperintense onFigure 60-1 Longitudinal ultrasound image shows tw Ebook Gastrointestinal imaging: Part 2o hepatic cysts (arrows) in the liver. One IS 3.5 cm in diameter and the other is 1.8 cm. Notice imperceptible walls, posterior acoustic enhancement,Ebook Gastrointestinal imaging: Part 2
and absence of internal echoes.37Ì372 Gastrointestinal ImagingFigure 60-2 Hepatic cyst at CT. Dynamic CT images before (A) and. after contrast adminisSection VIIIFocal Liver DiseaseCHAPTER 60Cystic Hepatic TumorsJin-Young Choi, Guilhcrmo Moura da Cunha. Beatriz c. Baranski Kantak, and Claude B. Sirl Ebook Gastrointestinal imaging: Part 2on the unenhanced image. It does not enhance on any of the postcontrast images. Its wall Is imperceptible.diffusion-weighted sequences (Figure 60-3). Enhancement does not occur after administration of contrast agents.Hepatic cysts are rarely complicated by intracystic hemorrhage or inflammation; suc Ebook Gastrointestinal imaging: Part 2h cysts may have low-level echoes at ultrasound, intermediate to high attenuation at CT, and heterogeneous signal intensity at both Tl-andT2-weightedEbook Gastrointestinal imaging: Part 2
imaging. Fluid-fluid levels may be visible when mixed blood products are present. Complicated cysts may also have septations, slightly thickened wallsSection VIIIFocal Liver DiseaseCHAPTER 60Cystic Hepatic TumorsJin-Young Choi, Guilhcrmo Moura da Cunha. Beatriz c. Baranski Kantak, and Claude B. Sirl Ebook Gastrointestinal imaging: Part 2tical to that of sporadic hepatic cysts except that the cysts in polycystic liver disease are much more numerous (Figure 60-4), are more likely to be hemorrhagic, and— dependingon their size, number, and location—may cause narrowing of portal veins, hepatic veins, or inferior vena cava. In cases com Ebook Gastrointestinal imaging: Part 2plicated by venous obstruction, intrahepatic collateral vessels may be observed. The liver drained by compressed hepatic veins may be congested and shEbook Gastrointestinal imaging: Part 2
ow a heterogeneous ("nutmeg") enhancement pattern after the administration of contrast.Differential Diagnosis■ Hydatid cyst: History to exposure to doSection VIIIFocal Liver DiseaseCHAPTER 60Cystic Hepatic TumorsJin-Young Choi, Guilhcrmo Moura da Cunha. Beatriz c. Baranski Kantak, and Claude B. Sirl Ebook Gastrointestinal imaging: Part 2sts on the inside of the main cyst are usually seen.Figure 60-3 Hepatic cyst at MRI. A 76-year-ofd woman with a 6.S-cm hepatic cyst. Dynamic T1-weighted MR images at 3T were acquired before (A) and after odmnstraticn of gadobenate in the late hepatic arterial (B), portal venous (C). 3-minute delayed Ebook Gastrointestinal imaging: Part 2 hepatobitary (D). and 60-minute delayed hepatobhary (E) phases. The cyst's wall (while anew) IS imperceptible and does not enhance cn any of the posfEbook Gastrointestinal imaging: Part 2
contrast images. Notice excretion ot contrast material into the bte duct in the hepatobiliary phase (black anew in E): as cysts do not communicate witSection VIIIFocal Liver DiseaseCHAPTER 60Cystic Hepatic TumorsJin-Young Choi, Guilhcrmo Moura da Cunha. Beatriz c. Baranski Kantak, and Claude B. Sirl Ebook Gastrointestinal imaging: Part 2on T2-we>ghted (G) images. It IS markedly hypenntense on a b - 0 s/rrnv (H) image and. owing to T2 shne-thrcugh. mmimalty hyperintense on a moderately bffusion-weighted b - SOO s/mm' image (I) The cysts has a high apparent cHfusion coefficient (J)■Abscess: Encapsulated cystic mass with surrounding e Ebook Gastrointestinal imaging: Part 2dema; patients typically have fever and an elevated white count.■Biliary cystadenoma: Encapsulated cystic mass with numerous septations typically diagEbook Gastrointestinal imaging: Part 2
nosed in a middle-aged woman.■Cystic metastasis: Seen in the presence of a known malignancy; typically has an enhancing irregular rim of viable neoplaSection VIIIFocal Liver DiseaseCHAPTER 60Cystic Hepatic TumorsJin-Young Choi, Guilhcrmo Moura da Cunha. Beatriz c. Baranski Kantak, and Claude B. Sirl Ebook Gastrointestinal imaging: Part 2d warrants a more aggressive workup. Cysts complicated by hemorrhage or inflammation may be difficult to differentiate from cystic neoplasms. Intracystic hemorrhage is more frequently encountered in polycystic liver disease than in sporadic hepatic cysts. Rarely patients with AD polycystic liver dis Ebook Gastrointestinal imaging: Part 2ease require surgical interventionFigure 60-4 CT of autosomal dominant polycystic liver disease (A and B) shows cysts of the kidneys as well as the liEbook Gastrointestinal imaging: Part 2
ver.Section VIIIFocal Liver DiseaseCHAPTER 60Cystic Hepatic TumorsJin-Young Choi, Guilhcrmo Moura da Cunha. Beatriz c. Baranski Kantak, and Claude B. SirlSection VIIIFocal Liver DiseaseCHAPTER 60Cystic Hepatic TumorsJin-Young Choi, Guilhcrmo Moura da Cunha. Beatriz c. Baranski Kantak, and Claude B. SirlGọi ngay
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