1. Dr Muhammad Fiaz
MBBS,FRCR (I),MCPS,FCPS
Assistant Professor SATH
Consultant Musculoskeletal Radiologist
Alrazi Healthcare, Lahore

2. DR
MUHAMM
AD FIAZ

3. ULTRASOUND OF
HEPATOBLIARY SYSTEM WITH
CLINICAL PERSPECTIVE

4. Liver anatomy

5. Liver anatomy

6. Liver Segments

7. The Liver
1. Size .
2. Texture.
3. Hepatic vasculature . ( portal
vein & hepatic veins).
4. Intrahepatic biliary radicles.

8. Size of Liver:
Right lobe : 15 cm.
Left lobe: 10 cm.

9. Size of Liver:

10. Size of Liver:

11. The Liver
1. Size .
2. Texture.
3. Hepatic vasculature . ( portal
vein & hepatic veins).
4. Intrahepatic biliary radicles.

12. Texture .
 Normal .

13. Texture .
Abnormal .
Diffuse liver disease.
Fatty liver
Cirrhosis.
Focal liver lesion.

14. Ultrasonography of the liver
Fatty liver:
Increased echogenicity
Liver enlargement.
Not always uniform
Patchy distribution :specially in the right
lobe
Focal fat sparing: anterior to GB or PV

15. Diffuse liver disease
Fatty liver:

16. Diffuse liver disease
Fatty Liver

17. Diffuse Liver Disease
Liver cirrhosis:
coarse echopattern with:
Irregular surface.
Coarse texture
Isoechoic regeneration of nodules
Ascites may present
Large caudate lobe

18. Diffuse Liver Disease

19. Diffuse Liver Disease

20. Focal liver lesions
Benign
Cystic
Hemangioma
Adenoma
Focal nodular Malignant
hyperplasia HCC
Regeneration Metastasis
nodules Lymphoma
Cholangiocarci
noma

21. Focal liver lesions
Liver cyst
Simple
Polycystic liver disease
Pyogenic abscess
Amebic abscess
Hydatid cyst.

22. Focal liver lesions
Simple Cysts

23. Focal liver lesions
Abscess

24. Focal liver lesions
Hydatid cyst

25. Focal liver lesions
Hydatid cyst

26. Focal liver lesions
Benign
Cystic
Hemangioma
Adenoma
Focal nodular hyperplasia
Regeneration nodules

27. Focal liver lesions
Haemangioma

28. Focal liver lesions
Benign
Cystic
Hemangioma
Adenoma
Focal nodular hyperplasia
Regeneration nodules

29. Focal liver lesions
Adenoma
Iso or hypoechoic
Central hypoechoic area
Solitary or multiple
More in females ( Oral
Contraceptive )

30. Focal liver lesions
Adenoma

31. Focal liver lesions
Benign
Cystic
Hemangioma
Adenoma
Focal nodular hyperplasia
Regeneration nodules

32. Focal liver lesions
Focal nodular hyperplasia
Second most common benign focal
lesion after haemangioma.
Well defined
More in the right lobe
May have a central scar
More in female 20 – 40 years.
homogenously isoechoic, but may
slightly hyper- or hypoechoic

33. Focal liver lesions
FNH

34. Focal liver lesions
FNH

35. Focal liver lesions
Benign
Cystic
Hemangioma
Adenoma
Focal nodular hyperplasia
Regeneration nodules

36. Focal liver lesions
Regeneration Nodules

37. Focal liver lesions
Malignant
HCC
Metastasis
Lymphoma
Cholangiocarcinoma

38. Focal liver lesions

39. Focal liver lesions

40. Focal liver lesions
Malignant
HCC
Metastasis
Lymphoma
Cholangiocarcinoma

41. Focal liver lesions

42. Focal liver lesions

43. Focal liver lesions
Malignant
HCC
Metastasis
Lymphoma
Cholangiocarcinoma

44. Focal liver lesions
 Klatskin Tumor - Hilar Cholangiocarcinoma
 The most common site of biliary adenocarcinoma
These tumors are also known as Klatskin tumors.
Klatskin tumors have an aggressive biologic
behavior.

45. Focal liver lesions
Klatskin tumor

46. Vascular lesions

47. Portal Vein

48. Portal hypertension
Portal vein velocity
Normal
20.2 -33.3 cm/sec
Cirrhosis
11.0 cm/sec
Portal hypertension
15.9 cm/sec

49. Portal vein

50. Vascular lesions

51. QUIZ???

52. Diffuse Liver Disease
Schistosomal hepatic fibrosis: (Thickened portal
tracts):
Portal tracts appear in US as portal vein
radicles only. If the wall of these radicles are
thickened, we measure the portal tracts
(outer-outer diameter). If the diameter is
more than 3 mm in more than 3 tracts 
“Periportal Thickening”.

53. QUIZ??

55. Gall Bladder
Size
Wall thickness.
Contents
Stone.
Mud.
Parasites.
Polyp
Mass

56. Gall Bladder
Normal

57. Gall Bladder
Size
Wall thickness.
Contents
Stone.
Mud.
Parasites.
Polyp
Mass

58. Gall Bladder
Normal

59. Gall Bladder
Inflammation

60. Gall Bladder
Inflammation

61. Gall Bladder
Size
Wall thickness.
Contents
Stone.
Mud.
Parasites.
Polyp
Mass

62. Gall Bladder
Stones

63. Gall Bladder
Stones

64. Gall Bladder
Stones

65. Gall Bladder
Stones

66. Gall Bladder
Stones

67. Gall Bladder
Stones

68. Gall Bladder
Mud

69. Gall Bladder
Mud

70. Gall Bladder
Size
Wall thickness.
Contents
Stone.
Mud.
Parasites.
Polyp
Mass

71. Gall Bladder
Polyp

72. Gall Bladder
Mass

73. CBD
CBD dilatation if more than 8 mm.
IHBR
Normally they are not seen.
When dilated as in obstructed Jaundice
“double barrel sign” (portal vein tributary
and intrahepatic bile radicle).

74. CBD

75. CBD

76. CBD

77. QUIZ?

78. Segmental Adenomyomatosis
Segmental thickening of wall with
hypertrophy of smooth muscles.
Rokitansky-Aschoff sinuses may apear as
cystic spaces.