Focal liver disease

Macronodular tuberculosis (51), granulomatosis of the liver (60) and particularly liver metastases may likewise appear as focal liver diseases with differing echogenicity. Flaematomas are initially hyperechoic, but turn hypoechoic when they liquefy within a few days, and even become echofree at a later stage. Older haematomas usually revert to being hyperechoic. (48, 85)... 

Focal liver diseases Biopsy material cannot be guaranteed as being representative. A higher degree of diagnostic accuracy can be achieved by a 2 to 3 fold liver biopsy in the course of a laparoscopic-bioptic examination of both lobes of liver. The same is true for peliosis hepatis (236, 305), granulomas and chronic hepatitis C, for example. (120)... 

Imaging of patients with liver tumors is an important and highly relevant field of diagnostic imaging, due to the large number of patients with diffuse or focal liver disease (e.g., the increasing number of patients with viral hepatitis) or with at least potential involvement of the liver (e.g., patients with extrahepatic malignancies such as breast cancer or colorectal cancer). The aim of... 

The first step is to screen the liver for the presence of focal liver disease and the extent of steatosis. Focal liver lesions have been reported in up to 18% of living liver donors (Fulcher et al. 2001). The presence of malignant lesions disqualifies the candidate from donation. When benign lesions are present, their size and site must be carefully evaluated, especially if the lesion is on the surgical resection plane. 

Tang-B on, R, Vas, W., Weissman, J., Salimi, Z., Patel, R., Morris, L. Focal fatty liver lesions in alcoholic liver disease a broadened spectrum of CT appearances. Gastrointest. Radiol. 1985 10 133—137... 

The skin lesions are often the first sign of underlying liver cell damage. Clinically, overt liver disease is uncommon, but minor alterations in biochemical tests of liver function are present in more than 50% of patients. Needle biopsy of the liver reveals hepatic siderosis in most patients, usually accompanied by minor histopathological abnormalities nfild fatty infiltration, focal necrosis of hepatocytes, and inflammation of portal tracts. Cirrhosis is unusual, being present in less than 15% of patients, but carries a high risk of hepatocellular carcinoma. 

Extracellular gadolinium-based contrast agents are still highly important in liver imaging. However, there are also tissue-specific contrast agents available, which allow for an increased detection rate and more specific characterization of focal and diffuse liver diseases. 

Nervous system Fluorouracil can cause acute nervous system toxicity. Acute cerebellar syndrome affects up to 5% of patients and is usually self-limiting after withdrawal. It can occur within weeks to months of starting fluorouracil and presents with ataxia, nystagmus, and dysarthria [77, 78 ]. An encephalopathy can occur rarely and is often associated with markedly raised ammonia concentrations in the absence of underlying liver disease. Ischemic stroke has also been reported and the risk appears to be increased when fluorouracil is combined with cisplatin [60, 79 ]. Other rare adverse reactions include oculomotor disturbances, focal dystonia, parkinsonian syndrome, peripheral neuropathy, and seizures [80 ]. Dihydropyrimidine dehydrogenase deficiency also increases the risk of nervous system toxicity [81" ]. 

A wide variety of focal liver lesions can be diagnosed by ultrasound, notably cysts, for which it is the most specific and sensitive test (Gaines and Sampson 1989). They are seen as echo-free spherical spaces with thin, smooth walls and a characteristic band of brighter liver distally, caused by the lower attenuation of ultrasound by their fluid compared to the liver (Fig. 1.4) (Bryant et al. 2004). The same appearance characterises the individual cysts of dominant polycystic disease except that they may be very numerous (Kuni et al. 1978). The lesions themselves and the heterogeneous liver texture that results from the numerous bands of increased sound transmission make the detection of co-existent liver disease difficult or impossible. Similarly, haemorrhage into a cyst or superinfection are not usually detectable with ultrasound. 

Marn, C.S., Bree, R.L., Silver, T.M. Ultrasonography of liver technique of focal and diffuse disease. Radiol. Clin. North Amer. 1991 29 1151-1170... 

The liver only exhibits focal processes of disease, which may be primary or secondary and of nonspecific or specific genesis. 

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