| Tx/comments | |||
| Infectious | Pyogenic | Drain, abx | |
| Parasitic | Amoebic | Thick-walled w projections. Flagyl for diarrhea | |
| Echinococcus | Double walled, egg shell calcifications, daughter/hyatidic cysts Albendazole for weeks to prevent anaphylaxis. Surgery to remove - formal resection vs pericystectomy - do not spill! Can do alcohol injections |
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| Simple | Simple cyst vs polycystic liver | Thin-walled. Treat if symptomatic - drain into abdomen with fenestration/marsupialization. Polycystic - can tx with R hepatectomy if mass effect; possible transplant | |
| Neoplastic | Biliary cystadenoma |
Thick septations, calcifications, papillary projections. ER/PR stroma, need frozen biopsy. Tx: resection (malignant potential, c/f cancer in cyst lining. PET-CT can be useful. c/f HCC seeding from biopsy. |
|
Tri-phasic liver CT: arterial (30s), portovenous (50s), delayed venous (70s)
| Enhancing | Non-enhancing | |
| Benign |
Hemangioma |
biliary hamartoma |
| Malignant |
HCC |
Mets - colorectal (CK7-, CK20+) - UGI (pancreas, stomach) (CK7+, CK20-) Intrahepatic cholangiocarcinoma |
| Imaging/pathology | Natural history | |
| Hemangioma | Peripheral nodular arterial enhancement, delayed venous filling, centripetal filling |
No malignant potential; don't operate on this. If need to core biopsy, do it through the liver to reduce bleeding ?Kasabach-Merritt syndrome in peds - consumptive coagulopathy/thrombocytopenia |
| FNH | Central stellate scar (pathognomonic) Proliferation of hepatocytes and bile ducts |
Resect if symptomatic (pain) |
| Hepatic adenoma | Proliferation of hepatocytes, without bile ducts |
Hormone responsive (estrogen, anabolic steroids) + malignant potential (> 4-5 cm) Resect if symptomatic, or prior to pregnancy (increased risk for rupture) |
| HCC | Delayed venous washout |
HCC treatment options
| Indications | Contraindications | |
| TACE | ||
| Ablation | Not preferred for lesions near large vessels (acts at heat sink/less effective) | |
| Resection | ||
| Transplantation | Milan vs UCSF criteria - 1 tumor > 5 cm, 3 tumors > 3 cm, etc... |
Lymphovascular invasion (tumor thrombus, visible lymph node involvement, etc.) |