Please answer the questions according to the figures: 1. Please describe the figures in ultrasonic term? 2. What is your diagnosis about the patient? 3. What differential diagnoses should you think about?
Case 5
Describe sonographic appearances of diffuse hepatic lesions.
Case 6
A 63 year-old man found a renal lesion in health examination. Physical exam: no positive signs.
Early stage： (inflammatory , no abscess) • Hypoechoic • Irregular border • Abundant CDFI
The ultrasound appearance of an abscess may be variable depending on the internal consistency of the mass.
Liver abscess
Liquefied stage：(abscess lumen)
Complex: with some debris and irregular walls.
Absorbent stage
Hypoechoic area
Liver metastases
The following three specific patterns have been described: ➢ A Well-defined hypoechoic mass. ➢ A Well-defined hyperechoic mass. ➢ Diffuse distortion of the normal homogeneous
Polycystic liver
Polycystic renal
Polycystic spleen
Of patients with polycystic liver disease, 60% have associated polycystic renal disease.
Liver abscess
parenchymal Pattern without a focal mass.
Metastatic disease appear as well-defined hyperechoic lesions throughout the liver.
Multiple hypoechoic solid nodules with clear margin bull's-eye configuration ( halo)
WES （ Wall-echo-shadow ）Sign
When the gallbladder is completely packed full of stones, the sonographer will only be able to image the stones casting a distinct acoustic shadow known as the wall echo shadow (WES) sign.
Case 3
According to the characteristics of ultrasonic imaging, what kind of diagnosiive the reasons?
Case 4
a
b
cC
d
Describe sonographic appearances of cystic, complex and solid hepatic lesions.
The system of digestion
● Spleen
Normal Anatomy
Location: left hypochondriac region Shape: bean Length:8-12cm;width:3-4cm; The echo intensity is usually slightly less than that of the liver.
The system of digestion
Polycystic liver disease
The cysts are small, under 2 to 3 cm, and multiple throughout the hepatic parenchyma. On ultrasound examination the cyst generally present as anechoic, well-defined borders with acoustic enhancement.
Metastatic disease appears as diffuse hypoechoic lesions with unclear margin.
The system of digestion
● Gallbladder
Gallstones may take several different shapes and size.
Cyst
Hemangioma
Hyperechoic/ mixed echoic lesion Clear margin
Lymphoma
Splenomegaly
Case analysis
Case 1
A 61 years old man. The history of pancreatic tumor surgery. What kind of diagnosis may be made for and please give the reasons?
Case 2
A 56 year-old man found a liver lesion during his routine health examination. What kind of diagnosis may be made for and please give the reasons?