ABDO Liver: Trauma & Vasc

Playlist contributed by: Dr Annabelle Skelley

Portal Vein Thrombosis

  • Complication of cirrhosis or portal vein invasion 
  • Malignant: expanded, contiguous with tumour 

Budd-Chiari 

  • Group of disorders characterised by obstruction to hepatic venous outflow -> causes increased pressure in hepatic sinusoids -> congestion, portal HTN and decreased hepatic pefusion 
  • Urgent diagnosis -> rapid progression
  • Causes: coagulation disorders, membranous webs in hepatic veins or IVC and malignant tumour invasion 
  • LPV: peripheral enhancement, central washout, caudate lobe spared
  • Caudate -> enlarged, normally enhances 
  • Thrombus in hepatic veins 

Nutmeg Liver

  • Perfusion abnormality -> mottled pattern of enhancement of AP & PVP with decreased peripheral enhancement, more uniform on delayed 
  • Causes: hepatic veno-occlusive disease, Budd-Chiari, congestive hepatopathy (CHF)
  • Budd Chiari -> look for normal enhancement of caudate

Peliosis Hepatis

  • Rare
  • Chronic wasting from cancer or Tb 
  • Associated with OCP and anabolic steroids 
  • Imaging: cystic dilatation of hepatic sinusoids and multiple small blood-filled spaces
  • MR: variable hypo/hyper T1; T2 high; no AP, progressive delayed enhancement on PVP & LVP 

Liver Infarction

Veno-Occlusive Disease

  • Similar to Budd-Chiari (hepatic congestion) 
  • Post-sinusoidal portal hypertension 
  • Causes: bone marrow transplant, chemotherapy, Jamaican bush tea
  • US: hepatomegaly, portal vein abnormality, GB wall thickening, ascites
  • CT: hepatomegaly, dilated PV, nutmeg liver, ascites
  • MR: HCSC: diffuse hypointense reticular pattern on HBP (highly specific) 
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rID: 21548
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