Ascites is defined as an abnormal amount of intraperitoneal fluid.
Patients with a large volume of ascites can present with abdominal distension (which may be painful), nausea, vomiting, dyspnoea and peripheral oedema 7, 9.
Ascitic fluid is traditionally chara...
Autoimmune hepatitis is a rare type of chronic hepatitis, currently classified as "type 1" or "type 2". It may eventually lead to cirrhosis. The role of imaging is primarily to exclude other diagnoses and evaluate for complications.
It may occur in children or adults, but most pat...
Autosplenectomy denotes spontaneous infarction of the spleen with resulting hyposplenism.
Autosplenectomy is most frequently encountered in patients with homozygous sickle cell disease, although it has also been reported in pneumococcal septicaemia 1, and SLE 2. The demographics t...
Beta catenin mutated hepatic adenomas are a genetic and pathologic subtype of hepatic adenoma. Their appearance and prognosis are different than other subtypes.
They are the least common subtype of hepatic adenoma (10-15%). They occur more frequently in men and are associated with...
Ascariasis is the commonest helminthic infection world wide and estimated to affect nearly 1 billion people (25% of population). The disease is transmitted by Ascaris lumbricoides which belongs to the nematode family (roundworms).
Infection occurs by ingestion of contaminated food (...
Bilomas refer to extrabiliary collections of bile. They can be either intra- or extrahepatic.
There is a slight discrepency in the reported literature in the use of the term "biloma". Many authors have used it exclusively to refer to intrahepatic bile collections or other bilious ...
Serum CA-125 is well recognised as an ovarian cancer-associated marker and is an antigen determinant on a high-molecular-weight glycoprotein. The normal range of CA-125 is 0-35 U/mL.
Serum CA-125 levels can also be used to monitor the response to treatment as well as a prognostic indicator sinc...
CA 19-9 is a serum antigen (monosialoganglioside) that has increased diagnostic use in the management of several malignancies, mainly of hepato-pancreatico-biliary origin. It is nonspecific, however, and can rise in both malignant and nonmalignant conditions.
Elevation of serum CA 19-9 has been...
Serum carcinoembryonic antigen (CEA) is a cell-adhesive glycoprotein that was discovered in colorectal cancer in 1965, and is hence one of the oldest and most used tumour markers. Its name derives from its normal expression in fetoembryonic liver, gut and pancreas tissue.
Normal range of CEA is...
Cardiac sclerosis, or "cardiac cirrhosis" is the end-point of passive hepatic congestion from heart failure.
Causes of cardiac cirrhosis include 1:
ischaemic heart disease: ~30%
valvular heart disease: ~25%
restrictive lung disease: ~15%
Caroli disease is a congenital disorder comprising of multifocal cystic dilatation of segmental intrahepatic bile ducts. However, some series show that extrahepatic duct involvement may exist 2. It is also classified as a type V choledochal cyst, according to the Todani classification.
Chemotherapy induced cholangitis is caused when intra-arterial chemotherapy is introduced to treat liver metastases. This causes strictures of the common hepatic duct and main ducts, but spares distal and proximal (i.e. common bile duct and intrahepatic ducts).
Cholangiocarcinoma is a malignant tumour arising from cholangiocytes in the biliary tree. It tends to have a poor prognosis and high morbidity. It is the second most common primary hepatic tumour, with intrahepatic cholangiocarcinomas (ICCs) accounting for 10-20% of primary liver tumours.
Choledocholithiasis denotes the presence of gallstones within the bile ducts (common hepatic duct / common bile duct).
Choledocholithiasis is relatively common, seen in in 6-12% of patients who undergo cholecystectomy 2.
Stones within the bile duct are ofte...
Chronic cholecystitis refers to prolonged inflammatory condition that affects the gallbladder. It is almost always seen in the setting of cholelithiasis (95%), caused by intermittent obstruction of the cystic duct or infundibulum or dysmotility.
Patients may have a histor...
Chronic pancreatitis represents the end result of a continuous, prolonged, inflammatory and fibrosing process that affects the pancreas. This results in irreversible morphologic changes and permanent endocrine and exocrine pancreatic dysfunction.
The most common cause of chronic p...
Clonorchiasis is a trematodiasis caused by chronic infestation by Clonorchis sinensis, and can lead to recurrent pyogenic cholangitis, biliary strictures and cholangiocarcinoma.
Infection with Clonorchis sinensis occurs in endemic areas, mainly east China. Over 85 million people ...
Emphysematous cholecystitis is a rare form of acute cholecystitis where gallbladder wall necrosis causes gas formation in the lumen or wall. It is a surgical emergency, due to the high mortality from gallbladder gangrene and perforation.
Men are affected twice as commonly as women...
Endocrine tumours of the pancreas arise from the pancreatic islet cells and include some distinct tumours that match the cell type of origin.
Pancreatic endocrine tumours have commonly been referred to as "islet cell tumours", referring to the islets of Langerhans, from which they...
Exophytic hepatic mass or tumour is a lesion which predominantly lies outside the margins of liver but originates from within the liver.
Causes include 1:
focal nodular hyperplasia
Extrapulmonary tuberculosis (TB) refers to the haematogenous spread of Mycobacterium tuberculosis.
Extrapulmonary tubercuosis can occur as a primary form of the disease, i.e. direct infection of an extrapulmonary organ without the presence of primary pulmonary tuberculosis or it can ...
Flash filling hepatic venous malformations, also known as flash filling hepatic haemangiomas, are a type of atypical hepatic venous malformation (haemangioma), which due to its imaging features often raises the concern of a malignant process rather than a benign one.
It is importa...
Gallbladder carcinomas are usually asymptomatic until they reach an incurable stage. As such, early incidental detection is important, if the occasional patient is to be successfully treated. The majority (90%) are adenocarcinomas, and the remainder are squamous cell carcinomas.
Gallbladder dysfunction, or functional gallbladder disorder, refers to biliary pain due to motility disturbance of the gallbladder without gallstones, biliary sludge, microlithiasis or microcrystals. The disorder has previous been known by several other names, including gallbladder dyskinesia, g...
Gallbladder hydrops refers to marked dilatation of the gallbladder due to chronic obstruction of the cystic duct results in accumulation of the sterile non-pigmented mucin.
Abdominal pain with palpable gallbladder without any signs of infection. In an asymptomatic patient...
Gallbladder perforations are a relatively rare complication that can occur in some situations but occurs most frequently as a result of acute cholecystitis. It can carry a relatively high mortality rate. It can also occur during laparoscopic cholecystectomies with the incidence of gallbladder pe...
Gallbladder polyps are elevated lesions on the mucosal surface of the gallbladder. The vast majority are benign, but malignant entities are possible. Gallbladder polyps may be detected on ultrasound, CT, or MRI, but are usually best characterized on ultrasound.
Gallbladder polyps ...
Gallbladder volvulus is a relatively rare condition in which there is a rotation of the gallbladder around the axis of the cystic duct and artery.
Symptoms are non-specific, however right upper quadrant pain and vomiting are similar to biliary colic. Laboratory evaluation...
Gallstone pancreatitis refers to pancreatitis caused by gallstones, specifically distal choledocholithiasis. Gallstones is the cause for 35-40% of acute pancreatitis but this number has a wide regional variance.
Gallstone pancreatitis has a higher incidence in women (compared to ...
Gallstones, also called cholelithiasis, are concretions that occur anywhere within the biliary system, most commonly within the gallbladder.
Gallstones (cholelithiasis) describes stone formation at any point along the biliary tree. Specific names can be given to gallstones dependi...
Gangrenous cholecystitis is the most common complication of acute cholecystitis, affecting ~15% (range 2-30%) of patients.
Gangrenous cholecystitis occurs as a result of ischaemia with necrosis of the gallbladder wall 4.
Gastrinomas are the second most common pancreatic endocrine tumour and the most common type in the setting of multiple endocrine neoplasia type I (MEN I).
Most gastrinomas are sporadic, although some are seen in the setting of multiple endocrine neoplasia type I (MEN I). In genera...
Glucagonomas are pancreatic endocrine tumours that secrete glucagon. Most lesions are malignant.
They are rare with an incidence of 0.000005%. Equal incidence in middle-aged men and women.
Most patients present with a necrolytic migratory rash and various ...
Haemorrhagic cholecystitis refers to an inflammatory process of the gallbladder, complicated by haemorrhage into the lumen.
The presenting features may mimic non-haemorrhagic acute cholecystitis, with right upper quadrant pain being a dominant feature. If the blood is pa...
Haemorrhagic pancreatitis is a possible uncommon complication that can occur with pancreatitis and is characterised by bleeding within or around the pancreas. It is usually considered a late sequela of acute pancreatitis.
Haemorrhage can occur in patients with severe necrotising panc...
Angiomyolipoma (AML) is an uncommon benign hamartomatous hepatic mass lesion, containing blood vessel (angioid), smooth muscle (myoid) and mature fat (lipoid) components. There is an association with tuberous sclerosis, although this is less strong than for renal AMLs.
Hepatic angiosarcoma is a rare malignancy but is still the third most common primary liver tumour. They have a variable appearance on both CT and MRI reflecting the pleomorphic histological nature. Prognosis is very poor, with survival uncommon beyond one year from diagnosis.
Primary hepatic carcinoid is an extremely rare type of carcinoid tumor, with somewhere between 60-90 cases reported in the literature. Metastatic carcinoid tumor from the gastrointestinal tract to the liver is far more common.
Some patients present with carcinoid syndrome...
Hepatic carcinosarcoma is a very rare tumour that is defined by mixed histological features.
This tumour has also been referred to as malignant mixed tumour, spindle cell carcinoma, pseudosarcoma or sarcomatoid carcinoma 1,2.
Hepatic carcinocarcinoma contain a mixture...
Hepatic haemangiomas, also known as hepatic venous malformations, are benign non-neoplastic hypervascular liver lesions. They are frequently diagnosed as an incidental finding on imaging, and most patients are asymptomatic. From a radiologic perspective, it is important to differentiate haemangi...
Hepatic haemosiderosis refers to the deposition of haemosiderin in the liver.
Hepatic iron overload can be in the form of 7
In the absence of genetic haemochromatosis and system...
Hepatic inflammatory pseudotumours (IPT) are rare benign hepatic lesions.
Most common in young adults with males affected more than females 7.
Aetiology is unknown 7.
Hepatic IPT is often seen as a well-circumscribed, encapsulated inflammator...
Hepatic leiomyosarcomas are rare primary malignant tumors derived from smooth muscle cells in the liver.
Hepatic leiomyosarcoma is rare 1. An equal sex distribution and a broad age range (5 months-66Y) has been reported. Some have suggested an associated with AIDS 2.
Hepatic lymphoma is a rather broad term given to any form of hepatic involvement with lymphoma. This can be broadly divided into:
secondary hepatic involvement with lymphoma: most common by far, many tend to be non-Hodgkin lymphoma (NHL) 1
primary hepatic lymphoma: extremely rare
Hepatic mesenchymal hamartoma is an uncommon benign hepatic tumour. Some authors even consider this to be a developmental anomaly rather than a cystic neoplasm 9,12.
It typically occurs in children and neonates, with most cases presenting within the first two years of life 3. Ther...
Hepatic solitary fibrous tumours (hepatic SFTs) are rare mesenchymal tumours.
Fewer than 60 cases have been reported in the literature. Female predominance (~70%). There is a mean age of 52 years at presentation, but a wide range of incidence (16-84 years).
Hepatic veno-occlusive disease (VOD), also known as sinusoidal obstruction syndrome (SOS), is a condition arising from occlusion of hepatic venules.
right upper quadrant pain
abnormal liver function tests
Toxic injury to liver s...
Hepatisation of the gallbladder is a sonographic entity in which the gallbladder lumen is entirely filled with tumefactive sludge giving the gallbladder a similar appearance to liver parenchyma. It is one of the causes of non-visualisation of the gallbladder on sonography.
In the set...
Hepatoblastoma is the most common primary malignant liver tumour in children under four years of age who usually present with painless abdominal mass and raised AFP. It is tumour of embryonic origin.
Most cases are seen during the first 18 months of life and diagnosis in adulthood...
Although hepatoblastomas can be histologically classified into a variety of sub types, it is important to remember that with the possible exception of small cell undifferentiated sub type, prognosis is independent of histology when adjusted for stage gender and age 1.
Hereditary haemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu syndrome, is a rare inherited disorder characterised by abnormal blood vessel formation in the skin, mucous membranes, and organs including the lungs, liver, and central nervous system.
HNF 1 alpha mutated hepatic adenomas are a genetic and pathologic subtype of hepatic adenoma. Their appearance and prognosis is different than other subtypes.
They are the second most common (30-35%) hepatic adenoma, after the inflammatory subtype. They occur only in female patien...
Infantile hepatic haemangiomas (IHH) are a liver lesion composed of large endothelial-lined vascular channels seen in fetuses and neonates. It should not be confused with a hepatic epithelioid haemangioendothelioma, which occurs in older patients.
Those benign tumours were previous...
Inferior vena cava (IVC) webs are an uncommon condition characterised by obstruction of the hepatic segment of the inferior vena cava by a membrane or fibrous band. This is often associated with occlusion of one or more of the hepatic veins.
If there is hepatic vein invol...
Inflammatory hepatic adenomas are a genetic and pathological subtype of hepatic adenoma. Their appearance and prognosis is different than other subtypes and has highest incidence of haemorrhage amongst hepatic adenoma subtypes.
Most common subtype of hepatic adenoma (40-50%). Occu...
Inflammatory myofibroblastic tumours (IMT), also known as plasma cell granulomas, are rare neoplasms that have a diverse spectrum of biological behaviour.
It can occur at any age and there is currently no recognised gender predilection.
Composed of spindle cells (key ...
Insulinomas are the most common sporadic endocrine tumour of the pancreas.
Account for 40% of syndromic pancreatic endocrine tumours. Overall incidence of ~0.0003%.
Typically insulinomas present with Whipple's triad consisting of:
fasting hypoglycemia (<50...
Interstitial oedematous pancreatitis is one of the two subtypes of acute pancreatitis. It is normally referred to as "acute pancreatitis" or "uncomplicated pancreatitis" in day-to-day use. Please refer to the article on acute pancreatitis for further details.
Intraductal papillary mucinous neoplasms or tumours (IPMNs or IMPTs) are cystic tumours of the pancreas.
These tumours are most frequently identified in older patients (50-60 years of age) 6. Main duct type (see below) appears to present a decade or so earlier on average than bran...
Jaundice refers to a clinical sign of hyperbilirubinemia (>2.5 mg/dl) which has many causes. It is often a clue to a diagnosis. It can be largely divided into two types:
non-obstructive, i.e. pre-hepatic and hepatic causes
obstructive, i.e. post-hepatic causes
Imaging has a major role in dete...
Klatskin tumour is a term that was traditionally given to a hilar cholangiocarcinoma, occurring at the bifurcation of the common hepatic duct. Typically, these tumours are small, poorly differentiated, exhibit aggressive biologic behaviour, and tend to obstruct the intrahepatic bile ducts.
This originally French article needs further translation and merging with the existing English article on hydatid disease.
Le kyste hydatique est une affection parasitaire due au taenia granulosis, considérée comme une zoonose atteignant aussi bien l'homme que les animaux, notamment les carnivo...
Limy bile stands for the presence of a viscous substance in the dependent parts of the gallbladder and/or bile ducts, almost entirely composed of calcium carbonate, and therefore highly radiopaque.
The terms limy bile and calcium milk gallbladder can be used interchangeably for inc...
Mastocytosis is a disorder of excessive mast cell proliferation, which is now classified as a myeloproliferative neoplasm. Two clinical entities fall under the mastocytosis umbrella: cutaneous (urticaria pigmentosa) and systemic mastocytosis (with or without cutaneous manifestations). The articl...
Myelofibrosis is a haematological disorder where there is the replacement of bone marrow with collagenous connective tissue and progressive fibrosis. It is also classified as a myeloproliferative disorder. It is characterised by:
extramedullary hematopoiesis (EMH)
Nonalcoholic fatty liver disease (NAFLD) occurs when fat is deposited into hepatocytes without a known cause (such as with alcoholic fatty liver disease). The deposition of fat may lead to hepatic inflammation (hepatitis) and may eventually lead to cirrhosis.
"Nonalcoholic fatty li...
Pancreatic intraepithelial neoplasia (PanIN) is a precursor lesion to pancreatic ductal adenocarcinoma, but the frequency at which this transition occurs is unknown.
Increasing incidence with age 1. Risk factors:
pancreatic lipomatosis 3
More commonly locat...
Pancreatic lipomatosis refers to fatty replacement of pancreatic parenchyma. This finding is most often associated with obesity and aging.
It tends to be commonest pathological condition involving the pancreas. The condition may occassionally simulate a mass like lesion particularly when fatty...
Pancreatic lymphoma is most commonly a B-cell sub-type of non-Hodgkin lymphoma and is classified as either primary or secondary:
primary pancreatic lymphoma is a rare extranodal manifestation of any histopathologic subtype of B-cell non-Hodgkin's lymphoma, representing < 2% of extranodal lympho...
Pancreatic pseudocysts are common sequelae of acute pancreatitis or chronic pancreatitis, and the most common cystic lesion of the pancreas. They are important both in terms of management and differentiation from other cystic processes or masses in this region.
The following are th...
The pancreas is uncommonly injured in blunt trauma. However, pancreatic trauma has a high morbidity and mortality. Imaging features range between subtle to obvious.
The pancreas is injured in ~7.5% (range 2-13%) of blunt trauma cases 1,3. Motor vehicle accidents account for the va...
Pancreatoblastomas are rare paediatric tumours of the pancreas. However, they are the most common pancreatic neoplasm of childhood and are often associated with a raised alpha-fetoprotein.
There is slight male predilection. Usually occurs in the first decade of life with a mean ag...
Paraduodenal pancreatitis is an uncommon type of focal chronic pancreatitis affecting the groove between the head of the pancreas, the duodenum and the common bile duct.
The following entities with which it shares clinicopathological features are unified by this term and should no ...
Passive hepatic congestion or congested liver in cardiac disease is the stasis of blood in the hepatic parenchyma, due to impaired hepatic venous drainage which leads to widening and splaying of the central hepatic veins and hepatomegaly.
Passive hepatic congestion is a well-studied result of ...
Portopulmonary hypertension (POPH/PPHTN) refers to pulmonary artery hypertension that develops in the setting of portal hypertension (with or without underlying liver disease). It falls under group 1.4 under the Dana point 2008 pulmonary hypertension classification system.
Post transplant lymphoproliferative/lymphoproliferation disorder (PTLD) is increasing in prevalence as the number and survival length of solid organ and bone-marrow transplant recipients also increases.
It represents a variety of conditions varying from lymphoid hyperplasia to malignancy but is...
Primary biliary cholangitis (PBC) is a chronic progressive cholestatic liver disease that is the cause of 1-2% of deaths from cirrhosis and constitutes the third most common indication for liver transplantation in adults.
The name of this disease was changed from primary biliary ci...
Primary hepatic lymphoma (PHL) is rare accounting for roughly 100 described cases. If it is being considered as a diagnosis, distal lymphadenopathy, splenomegaly, bone marrow disease, and leukaemia should not be present for at least 6 months after the liver tumour is detected (see: secondary hep...
Primary hyperoxaluria, also referred as primary oxalosis, is a congenital autosomal recessive disease related to a liver enzyme deficiency leading to massive cortical nephrocalcinosis and renal failure.
Please, refer on secondary oxalosis for a discussion on the acquired form of hyperoxaluria....
Pseudopancreatitis refers to the presence of fluid in or around the pancreas in the setting of trauma but in the absence of direct signs of traumatic pancreatic injury. Most patients will have a normal serum lipase level, but amylase has a limited sensitivity and specificity for pancreatic traum...
Rhabdomyosarcomas of the biliary tract are rare tumours, usually identified in children, with a very poor prognosis. They are usually grouped under botryoid rhabdomyosarcomas.
For a general discussion of this type of tumour, please refer to the article on rhabdomyosarcomas.
Sarcoidosis is a systemic inflammatory disease of unknown origin characterized by the formation of non-caseating granulomas. Virtually any organ system may be involved. Although the involvement of abdominal viscera is less frequent than pulmonary and mediastinal disease when it occurs, it may m...
Schistosomiasis (also referred to as bilharzia or snail fever) is the result of infection by blood fluke (trematode worm) of the Schistosoma species.
Schistosomiasis is very common, affecting over 200 million people, with the vast majority (85%) in Africa. It is prevalent in tropi...
Schistosomiasis hepatic manifestations are a chronic result of the deposition of eggs into small portal venules leading to periportal fibrosis and liver cirrhosis.
For a general view over this trematode infection, please refer to the main article on schistosomiasis.
Secondary hepatic involvement with lymphoma (secondary hepatic lymphoma) is common, much more so than primary hepatic lymphoma.
Hepatomegaly with deranged liver function tests is the most common presentation. Jaundice is common. Rarely, patients may present with acute li...
Serous cystadenoma of the pancreas (or microcystic adenoma) is an uncommon type of benign cystic pancreatic neoplasm.
There is a recognised strong female predilection (M:F ~ 1:4) and usually presents in middle age to elderly patients (>60 years of age).
Sickle cell disease (SCD) is an autosomal recessive condition resulting in the formation of abnormal haemoglobin (a haemoglobinopathy), which manifests as multisystem ischaemia and infarction, as well as haemolytic anaemia.
There is no recognised gender predilection. The highest ...
Simple hepatic cysts are common benign liver lesions and have no malignant potential. They can be diagnosed on ultrasound, CT, or MRI.
Simple hepatic cysts are one of the commonest liver lesions, occurring in ~2-7% of the population 1-2. There may be a slight female predilection.
Solid pseudopapillary tumours (SPT) of the pancreas are rare (usually benign) pancreatic tumours.
The tumour has been referred to with multiple different names, including:
solid pseudopapillary tumour (SPT) of the pancreas
solid pseudopapillary neoplasm (SPN)
Spindle cell hepatocellular carcinoma, also called sarcomatoid hepatocellular carcinoma, is a rare variant of hepatocellular carcinoma (HCC). These patients are reported to have low or normal AFP levels, otherwise risk factors and clinical presentation are similar to typical hepatocellular carci...
Splenic hamartomas are very rare and usually solitary although may be present as multiple nodules present in tuberous sclerosis or Wiskott-Aldrich syndrome.
The only recently described entity sclerosing angiomatoid nodular transformation (SANT) of the spleen, a non-neoplastic vascular entity de...
Splenic hydatid infection is a rare form of Hydatid disease, and isolated splenic involvement is even less common.
Splenic hydatid disease has been reported to constitute up to 4% of cases of abdominal hydatid disease 4.
Splenic hydatid cysts are usually solitary. As t...
Splenic infarction is a result of ischaemia to the spleen, and in many cases requires no treatment. However, identification of the cause of infarction is essential.
Splenic infarcts can occur due to a number processes, involving either arterial supply, the spleen itself and the ...