Images and text Genevieve Carbonatto
A 54 year old man presents to the Emergency Department with abdominal pain and jaundice. He has a distended abdomen. He is known to have alcoholic cirrhosis. A point of care ultrasound was performed. The following demonstrates some of the basic features of cirrhosis with ultrasound.
Liver size, increased echogenicity and the presence of ascites.
The right lobe of the liver is small. The liver appears hyperechoic but this may depend on gain. The gain in the above image is 50, while the gain below is 42. The same liver below appears to have normal echogenicity. In cirrhosis the echogenicity of the liver is variable but usually increased
One way to assess the echogenicity of the liver is to compare it to that of the kidney using the same gain settings. The liver should be isoechoic or hyperechoic compared to the kidney. In this case it appears to be much more echogenic than the kidney
The ascites is so extensive that the
It is easier to appreciate this ligament in the diagram below. Fluid surrounds this space entirely.
Gall bladder wall oedema:
Mesenteric varices:
Large mesenteric varices are present which light up with colour Doppler. This is a secondary sign of portal hypertension which includes splenomegaly, ascites and portosystemic venous collaterals.
The portal flow is still towards the liver (hepatopetalflow. )
The Portal flow Doppler shows a peak systolic velocity of 18 cm/sec.Normal main portal vein peak systolic velocities range between 20 cm/sec and 40 cm/sec. A low flow velocity of <16 cm/sec in addition to a caliber increase in the main portal vein are diagnostic features of portal hypertension.(3) In this case the portal vein was not measured but the velocity is over 16cm/sec.
Spleen:
The spleen in this case is not enlarged. It measures 9. 3 cm. Normal upper limit 14 cm
The cause of his abdominal pain was abdominal distention from his ascites. This was drained and he was discharged 2 days later.
References
- World J Hepatology : 2015 Aug 18; 7(17): 2069–2079. doi: 10.4254/wjh.v7.i17.2069PMCID: PMC4539400
Prediction of liver cirrhosis, using diagnostic imaging toolsSuk Keu Yeom, Chang Hee Lee, Sang Hoon Cha, and Cheol Min Park - Diagnostic Ultrasound : Rumack
- Ultrasonography. 2016 Jan; 35(1): 3–12.Altered Doppler flow patterns in cirrhosis patients: an overview Pooya Iranpour,1 Chandana Lall,1 Roozbeh Houshyar,1 Mohammad Helmy,1 Albert Yang,1 Joon-Il Choi,2 Garrett Ward,1 and Scott C Goodwin1