Ultrasonic pseudolesions of the liver

Diagnosis of hepatic cavernous hemangioma by fine needle aspiration biopsy under ultrasonic guidance

Percutaneous aspiration biopsy of the liver using a heparinized 22-gauge needle was performed under ultrasonic guidance in 11 patients with hepatic cavernous hemangioma. Ten (91%) of 11 biopsy specimens obtained were cytologically diagnostic for hemangioma. No indications of malignancy were found. There was no relation between the cytological diagnosis and the location, size, or ultrasonographic findings. No complications were encountered. These findings indicate that cytological examination of the liver by fine needle aspiration biopsy is useful in diagnosing hepatic cavernous hemangioma of any size and in any location, provided optimal route to the lesions is chosen.

Ultrasound-guided fine-needle aspiration biopsy in the diagnosis of hepatic hemangioma

Fine-needle biopsy of hepatic hemangioma is discussed on the basis of a series of 10 biopsies performed on eight patients. The fine needle biopsies were executed because of the atypical sonographic pattern of some lesions, or in order to exclude malignancy for others (five patients were known to have neoplasms). No complication presented during or after the punctures. In six cases cytologic samples included capillary vessels or endothelial cells, supplying the diagnosis of hemangioma. It is concluded that fine-needle biopsy of a hepatic hemangioma is not loaded with complications, and moreover can yield true positive information in 60% of cases.

Pediatric liver transplantation. Part II. Diagnostic imaging in postoperative management

The postoperative diagnostic imaging examinations of 44 children who underwent 59 orthotopic liver transplantations were reviewed. The imaging modalities used for the evaluation of suspected complications include plain roentgenography, ultrasonography (US), computed tomography (CT), nuclear scintigraphy, arteriography, percutaneous and operative cholangiography, and endoscopic retrograde cholangiopancreatography. The main postoperative complications included ischemia, thrombosis (hepatic artery and portal vein), infarction, obstruction or leakage of the biliary anastomosis, hepatic and perihepatic infection, and allograft rejection. US, the most frequently used abdominal imaging modality, was best suited for detection of biliary duct dilatation, fluid collections in or around the transplanted liver, and hepatic arterial, inferior vena caval, and portal vein thrombosis. CT was especially helpful in corroborating findings of infection and in locating abscesses. Technetium 99m sulfur colloid (early- and late-phase imaging) provided a sensitive, although nonspecific, means of assessing allograft vascularization and morphology. Angiography showed vascularity most clearly, and cholangiography was the most useful in the assessment of bile duct patency. A diagnostic imaging algorithm is proposed for evaluation of suspected complications.