Heptao billiary system
Different methods of imaging
1-us
2- C.T scan
3- M.R.I
4-E.R.C.P
5-P.T.C
LIVER
on us ; uniform echogensity of liver
parenchyma with brighted echo patteren
inside of ortal triad & echo free of large
hepatic veins
Size & shape are variable
Portal veins divided the liver into rt & lt lobe &
hepatic ducts & arteries are to small to be
visulize by US
CT of liver
Liver divided into 8 segment
Normal hepatic parenchyma density is as higher as
adgacent muscle & higher than the &spleen
precontrast& to some extent after contrast
Hepatic & portak veins are hypodense
Contrast use in assasment of the liver must be at
either 30 sec ( arterial phase 0 or 60-79sec ( portal
phase )
Arterial is suggestive for vascular kesions such
haemangioma
MRI of the liver
MRI is aproblem solving tecknique than us
& CT scan that give us coronal &saggital
view
Liver masses
Malignant masses are seen ak ;s metastasis as
(stomach ; colon ; lung ;……)
The metastasis apperance at us
A-multiple
B- peripheral
C-variable size
D-usualy hypoechoic but may be hyperechoic
ct appearance of liver metastasis is lower
density than tissue parenchyma
MRI show hypointense T1W ; hyper intense
T2w
Primary liver tumour are seen the same as
secondary metastasis
Benign liver masses
A- cyst
B-haemangioma
C- F.N.H
D-adenoma
E-liver abscces
Liver cirrhosis
Sign of livver cirrhosis at ctscan & us are
A- reduction of the size of the rt lobe of he
liver
B-irregular liver surface
C-splenomegaly
D-ascites
Billiary system
Is simply assas by us & to some extent
Radionuclide
Gall bladder is fluid filled structure that is best seen
by uswith wall thickness barely perceptable
Gb
acuteor chronic cholecystitis by wall thickening
CBD up to 7mmanterior to portal vein
Intra hepatic billiary tree hardly to be seen just in
their beginning where few mm dia
MRCP
A-easy
B- non invasive
ERCP ‘
Therapy &biopsy
PTC
Complication
A- haematoma
B- septcemia
C-billiary peritonitis
Gall stones & cholecystitis
20% of stone seen by plain film
By us dense echogenic with acoustic
shadowing which diffrentiate from polyp
CBD stone is seen by us but still MRCP is
supereme
Cholecystitis
1- gall stone
2-inflammatry debrise
3-wall thickening
4-rim &fluid adagcent to gall bladder ct scan by fat
stranding
Billiar obstruction is caused by;
1- stone 2-compresion 3- ca ampullae of vatter
4- cholangiocarcinoma
Pancreas
CT scan
Imaging of choice seen the pancreas regardeless
the bowels gas adjacent to it
1- nestle by duodenal cup
2-uncinate process behind SMV
3- body behind SMA
4- tail at hillum of spleen
Pancreatic masses
1- ca 2/3 in the head mostly adeno carcinoma
2- LN malignancy
3- focal pancreatitis
4- pancreatic abscess
5- pseudo cyst
Tumour less attenuation than pancreas
Staging is next step
Acute pancreatitis
Its diagnosis of clinical & biochemical
investigation
Ct & us are best for
1-necrosis & haemorragic suppuration
2- diffusly enlarge
3-irregularity
Chronic pancreatitis
1- fibrosis
2-stone
3- calcification ‘
4- pseudo cyst
Atrophy is non specific sign
Spleen
Us homogenous echo pattern like liver or less
DDX hydatid cyst ;lump;abscess ;tumour ;
enlarfe speen causes……..etc
Splenic trauma ;
Is the most common injured organ by blunt
trauma
1- laceration 2-contusion ; haematoma