Liver ultrasonography

IU/1. Serology and autoimmune screens were negative, as were liver ultrasonography and computerized tomography. Cholangiopancreatography was normal. Irbesartan was replaced by amlodipine and metoprolol, and 2 months later she remained jaundiced (bilirubin 324 pmol/l). Liver biopsy showed portal tract expansion, minimal inflammation, ectatic ductules, and cholestatic rosettes. Within 16 weeks she fully recovered and continued to be anicteric more than 1 year later. 

The incidence of liver tumors following the use of androgens and anabolic steroids still cannot be calculated. What is clear is that if these products are used in high doses or over long periods of time (and there is now much doubt about whether they are more than marginally effective in such conditions as osteoporosis and aplastic anemia), techniques such as CT scanning and ultrasonography should be used routinely to ensure early detection of liver lesions. 

Comparable reports have prompted a questionnaire investigation of 770 patients with type 2 diabetes at the start of acarbose therapy (62). Patients with one or more susceptibility factors for liver damage underwent ultrasonography and autoantibody assays. There was silent liver disease in 13% and 20 patients had a fatty liver without hepatic disease. In 15% of these patients there were slight reversible changes in transaminase activity after acarbose. 

A 61-year-old woman developed symptoms of acute hepatitis 6 weeks after she began to take fluvastatin sodium 20 mg/day for hypercholesterolemia (3). Ultrasonography and liver biopsy confirmed the diagnosis of non-obstructive intrahepatic jaundice. Studies of viral markers and autoimmune factors excluded viral hepatitis and autoimmune hepatitis. There was a high serum concentration of a metabolite of fluvastatin, suggesting a possible anomaly of drug metabolism. All liver function tests normalized 8 weeks after the withdrawal of fluvastatin. 

A 50-year-old man developed recurrent sharp lower abdominal pain and nausea, having taken modified-release nicotinic acid 500-2000 mg/day for 8 weeks for hypercholesterolemia. He had a low-grade fever, tachycardia, and hypotension. Abdominal ultrasonography showed a markedly hypoechoic liver of normal size,... 

J.S. D Arrigo, S.Y. Ho and R.H. Simon, Detection of experimental rat liver tumors by contrast-assisted ultrasonography, Invest. Radiol. 28 (1993) 218-222. 

Every enlarged liver, as well as every hard liver, must be considered pathological - until counter-evidence is produced by laboratory values and ultrasonography and, if necessary, by means of histology or laparoscopy. 

After years of experience with ultrasonography, a well-trained sonographer will produce highly reliable results in the field of liver imaging. The method neither inconveniences nor harms the patient. Thus there is a broad range of indications for examination by ultrasonography in patients with hepatobiliary diseases. There are no contraindications. Specific diagnostic statements, however, are rarely possible. 

In terms of ultrasonography, various liver diseases appear as diffuse changes in the parenchyma. They usually exhibit uncharacteristic findings. In cases where the diagnosis is uncertain, particularly after employing CT, liver biopsy (or laparoscopy) is then indicated ... 

Portal vein thrombosis (see chapter 39.3.3) with gradual or incomplete obstruction merely produces anastomoses and develops asymptomatically. After complete obstruction, ultrasonography will showparaportal, angiomatous anastomoses, predominantly in the porta hepatis (= cavernous transformation). (95) Splenomegaly is evidenced with a normal-sized liver. The portal vein is not detectable. Colour Doppler sonography has become of paramount importance in portal vein system diagnostics. 

Endoscopic ultrasonography promises greater accuracy as it involves placing a specialized sound transducer directly on the liver by means of laparoscopy or surgery. 

Abbitt, P.L. Ultrasonography-update on liver technique. Radiol. Clin. N. Amer. 1998 36 299-307... 

Charnley, R.M., Morris, D.L., Dennison, A.R., Amar, S.S., Hardcastle, J.D. Detection of colorectal liver metastases using intraoperative ultrasonography. Brit. J. Surg. 1991 78 45-48... 

Joseph, A.E.A., Saverymuttu, S.H., Al-Sam, S., Cook, M.G., Maxwell, J.D. Comparison of liver histology with ultrasonography in assessing diffuse parenchymal liver disease. Clin. Radiol. 1991 43 26-31... 

Lygidakis, N.J., Makuuchi, M. Clinical application of preoperative ultrasonography in liver surgery. Hepato-Gastroenterol. 1992 39 232-286... 

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... 

Platt, J.F., liUis, J.H., Rnbin, J.M., Merion, R.M., Lucey, M.R. Renal duplex Doppler ultrasonography a noninvasive predictor of kidney dysfunction and hepatorenal failure in liver disease. Hepatology 1994 20 362-369... 

Hultcrantz, R., Gabrielsson, N. Patients with persistent elevation of aminotransferases investigation with ultrasonography, radionucleide imaging and liver biopsy. J. Intern. Med. 1993 233 7-12... 

Scheimann, A.O., Barrios, JJM., AI-TawiI, Y.S., Gray, KJM., Gilger, MA. Percutaneous liver biopsy in children Impact of ultrasonography and springjoaded biopsy needles. J. Pediatr. Gastroenterol. Nutrit. 2000 31 536-539... 

Ferreyra, N.R, Cerri, G.G. Ascariasis of the alimentary tract, liver, pancreas and biliary system its diagnosis by ultrasonography. Hepa-togastroenterol. 1998 45 932-937... 

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