Liver mass causes: Difference between revisions

Jump to navigation Jump to search
No edit summary
m (Bot: Removing from Primary care)
 
(13 intermediate revisions by 4 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Liver mass}}
{{Liver mass}}
{{CMG}};{{AE}}{{NM}}; {{PSK}}; {{MV}}
{{CMG}}; {{AE}}{{NM}}; {{PSK}}; {{MV}}


==Overview==
==Overview==
The most common cause of a liver mass is hepatocellular carcinoma. Common causes of benign liver mass, include: hepatic hemangioma, focal nodular hyperplasia, hepatic adenoma, idiopathic noncirrhotic portal hypertension (including nodular regenerative hyperplasia, regenerative nodules. Common causes malignant liver masses, include: hepatocellular carcinoma, cholangiocarcinoma, metastatic disease.
The most common cause of a liver mass is [[hepatocellular carcinoma]]. Common causes of benign liver mass, include: [[hepatic hemangioma]], [[focal nodular hyperplasia]], [[Hepatocellular adenoma|hepatic adenoma]], idiopathic noncirrhotic [[portal hypertension]] (including nodular regenerative [[hyperplasia]] and regenerative nodules). Common causes of malignant liver masses, include: [[hepatocellular carcinoma]], [[cholangiocarcinoma]], and metastatic disease.


==Causes==
==Causes==
Common causes of liver mass incude:<ref name="pmid26770920">{{cite journal |vauthors=Kim TK, Lee E, Jang HJ |title=Imaging findings of mimickers of hepatocellular carcinoma |journal=Clin Mol Hepatol |volume=21 |issue=4 |pages=326–43 |year=2015 |pmid=26770920 |pmc=4712159 |doi=10.3350/cmh.2015.21.4.326 |url=}}</ref><ref name="Ferrell2000">{{cite journal|last1=Ferrell|first1=Linda|title=Liver Pathology: Cirrhosis, Hepatitis and Primary Liver Tumors. Update and Diagnostic Problems|journal=Modern Pathology|volume=13|issue=6|year=2000|pages=679–704|issn=0893-3952|doi=10.1038/modpathol.3880119}}</ref><ref name="KimLee2015">{{cite journal|last1=Kim|first1=Tae Kyoung|last2=Lee|first2=Eunchae|last3=Jang|first3=Hyun-Jung|title=Imaging findings of mimickers of hepatocellular carcinoma|journal=Clinical and Molecular Hepatology|volume=21|issue=4|year=2015|pages=326|issn=2287-2728|doi=10.3350/cmh.2015.21.4.326}}</ref><ref name="DooLee2009">{{cite journal|last1=Doo|first1=Kyung Won|last2=Lee|first2=Chang Hee|last3=Choi|first3=Jae Woong|last4=Lee|first4=Jongmee|last5=Kim|first5=Kyeong Ah|last6=Park|first6=Cheol Min|title=“Pseudo Washout” Sign in High-Flow Hepatic Hemangioma on Gadoxetic Acid Contrast-Enhanced MRI Mimicking Hypervascular Tumor|journal=American Journal of Roentgenology|volume=193|issue=6|year=2009|pages=W490–W496|issn=0361-803X|doi=10.2214/AJR.08.1732}}</ref><ref name="pmid17510541">{{cite journal |vauthors=Zech CJ, Herrmann KA, Reiser MF, Schoenberg SO |title=MR imaging in patients with suspected liver metastases: value of liver-specific contrast agent Gd-EOB-DTPA |journal=Magn Reson Med Sci |volume=6 |issue=1 |pages=43–52 |year=2007 |pmid=17510541 |doi= |url=}}</ref><ref name="ChengTsai1995">{{cite journal|last1=Cheng|first1=H C|last2=Tsai|first2=S H|last3=Chiang|first3=J H|last4=Chang|first4=C Y|title=Hyalinized liver hemangioma mimicking malignant tumor at MR imaging.|journal=American Journal of Roentgenology|volume=165|issue=4|year=1995|pages=1016–1017|issn=0361-803X|doi=10.2214/ajr.165.4.7676959}}</ref><ref name="pmid1370873">{{cite journal |vauthors=Haratake J, Horie A, Nagafuchi Y |title=Hyalinized hemangioma of the liver |journal=Am. J. Gastroenterol. |volume=87 |issue=2 |pages=234–6 |year=1992 |pmid=1370873 |doi= |url=}}</ref><ref name="TakayasuMoriyama1986">{{cite journal|last1=Takayasu|first1=K|last2=Moriyama|first2=N|last3=Shima|first3=Y|last4=Muramatsu|first4=Y|last5=Yamada|first5=T|last6=Makuuchi|first6=M|last7=Yamasaki|first7=S|last8=Hirohashi|first8=S|title=Atypical radiographic findings in hepatic cavernous hemangioma: correlation with histologic features|journal=American Journal of Roentgenology|volume=146|issue=6|year=1986|pages=1149–1153|issn=0361-803X|doi=10.2214/ajr.146.6.1149}}</ref><ref name="pmid11039718">{{cite journal |vauthors=Yamashita Y, Shimada M, Taguchi K, Gion T, Hasegawa H, Utsunomiya T, Hamatsu T, Matsumata T, Sugimachi K |title=Hepatic sclerosing hemangioma mimicking a metastatic liver tumor: report of a case |journal=Surg. Today |volume=30 |issue=9 |pages=849–52 |year=2000 |pmid=11039718 |doi= |url=}}</ref><ref name="KimLee20152">{{cite journal|last1=Kim|first1=Tae Kyoung|last2=Lee|first2=Eunchae|last3=Jang|first3=Hyun-Jung|title=Imaging findings of mimickers of hepatocellular carcinoma|journal=Clinical and Molecular Hepatology|volume=21|issue=4|year=2015|pages=326|issn=2287-2728|doi=10.3350/cmh.2015.21.4.326}}</ref><ref name="LeeKim2012">{{cite journal|last1=Lee|first1=So Jung|last2=Kim|first2=So Yeon|last3=Kim|first3=Kyoung Won|last4=Shin|first4=Yong Moon|last5=Kim|first5=Hyoung Jung|last6=Lee|first6=Jong Seok|last7=Kim|first7=Sun A|title=Hepatic angiomyolipoma with minimal fat, mimicking hepatocellular carcinoma|journal=Clinical and Molecular Hepatology|volume=18|issue=3|year=2012|pages=330|issn=2287-2728|doi=10.3350/cmh.2012.18.3.330}}</ref><ref name="pmid25231411">{{cite journal |vauthors=Kim R, Lee JM, Joo I, Lee DH, Woo S, Han JK, Choi BI |title=Differentiation of lipid poor angiomyolipoma from hepatocellular carcinoma on gadoxetic acid-enhanced liver MR imaging |journal=Abdom Imaging |volume=40 |issue=3 |pages=531–41 |year=2015 |pmid=25231411 |doi=10.1007/s00261-014-0244-4 |url=}}</ref><ref name="pmid19200676">{{cite journal |vauthors=Jeon TY, Kim SH, Lim HK, Lee WJ |title=Assessment of triple-phase CT findings for the differentiation of fat-deficient hepatic angiomyolipoma from hepatocellular carcinoma in non-cirrhotic liver |journal=Eur J Radiol |volume=73 |issue=3 |pages=601–6 |year=2010 |pmid=19200676 |doi=10.1016/j.ejrad.2009.01.010 |url=}}</ref><ref name="KimChoi1997">{{cite journal|last1=Kim|first1=T K|last2=Choi|first2=B I|last3=Han|first3=J K|last4=Jang|first4=H J|last5=Cho|first5=S G|last6=Han|first6=M C|title=Peripheral cholangiocarcinoma of the liver: two-phase spiral CT findings.|journal=Radiology|volume=204|issue=2|year=1997|pages=539–543|issn=0033-8419|doi=10.1148/radiology.204.2.9240550}}</ref><ref name="pmid9562062">{{cite journal |vauthors=Choi BI, Kim TK, Han JK |title=MRI of clonorchiasis and cholangiocarcinoma |journal=J Magn Reson Imaging |volume=8 |issue=2 |pages=359–66 |year=1998 |pmid=9562062 |doi= |url=}}</ref><ref name="GuoXu2015">{{cite journal|last1=Guo|first1=Le-Hang|last2=Xu|first2=Hui-Xiong|title=Contrast-Enhanced Ultrasound in the Diagnosis of Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma: Controversy over the ASSLD Guideline|journal=BioMed Research International|volume=2015|year=2015|pages=1–5|issn=2314-6133|doi=10.1155/2015/349172}}</ref><ref name="WilsonKim2007">{{cite journal|last1=Wilson|first1=Stephanie R.|last2=Kim|first2=Tae Kyoung|last3=Jang|first3=Hyun-Jung|last4=Burns|first4=Peter N.|title=Enhancement Patterns of Focal Liver Masses: Discordance Between Contrast-Enhanced Sonography and Contrast-Enhanced CT and MRI|journal=American Journal of Roentgenology|volume=189|issue=1|year=2007|pages=W7–W12|issn=0361-803X|doi=10.2214/AJR.06.1060}}</ref><ref name="pmid8511316">{{cite journal |vauthors=Ohtomo K, Baron RL, Dodd GD, Federle MP, Miller WJ, Campbell WL, Confer SR, Weber KM |title=Confluent hepatic fibrosis in advanced cirrhosis: appearance at CT |journal=Radiology |volume=188 |issue=1 |pages=31–5 |year=1993 |pmid=8511316 |doi=10.1148/radiology.188.1.8511316 |url=}}</ref><ref name="HussainSyed2004">{{cite journal|last1=Hussain|first1=Hero K.|last2=Syed|first2=Ibrahim|last3=Nghiem|first3=Hanh V.|last4=Johnson|first4=Timothy D.|last5=Carlos|first5=Ruth C.|last6=Weadock|first6=William J.|last7=Francis|first7=Isaac R.|title=T2-weighted MR Imaging in the Assessment of Cirrhotic Liver|journal=Radiology|volume=230|issue=3|year=2004|pages=637–644|issn=0033-8419|doi=10.1148/radiol.2303020921}}</ref><ref name="pmid8234718">{{cite journal |vauthors=Ohtomo K, Baron RL, Dodd GD, Federle MP, Ohtomo Y, Confer SR |title=Confluent hepatic fibrosis in advanced cirrhosis: evaluation with MR imaging |journal=Radiology |volume=189 |issue=3 |pages=871–4 |year=1993 |pmid=8234718 |doi=10.1148/radiology.189.3.8234718 |url=}}</ref><ref name="pmid19380559">{{cite journal |vauthors=Brancatelli G, Baron RL, Federle MP, Sparacia G, Pealer K |title=Focal confluent fibrosis in cirrhotic liver: natural history studied with serial CT |journal=AJR Am J Roentgenol |volume=192 |issue=5 |pages=1341–7 |year=2009 |pmid=19380559 |doi=10.2214/AJR.07.2782 |url=}}</ref><ref name="pmid15050225">{{cite journal |vauthors=Kelekis NL, Makri E, Vassiou A, Patsiaoura K, Spiridakis M, Dalekos GN |title=Confluent hepatic fibrosis as the presenting imaging sign in nonadvanced alcoholic cirrhosis |journal=Clin Imaging |volume=28 |issue=2 |pages=124–7 |year=2004 |pmid=15050225 |doi=10.1016/S0899-7071(03)00243-2 |url=}}</ref><ref name="pmid9880618">{{cite journal |vauthors=Ooi CG, Chan KL, Peh WC, Saing H, Ngan H |title=Confluent hepatic fibrosis in monozygotic twins |journal=Pediatr Radiol |volume=29 |issue=1 |pages=53–5 |year=1999 |pmid=9880618 |doi=10.1007/s002470050534 |url=}}</ref><ref name="pmid23688409">{{cite journal |vauthors=Park YS, Lee CH, Kim BH, Lee J, Choi JW, Kim KA, Ahn JH, Park CM |title=Using Gd-EOB-DTPA-enhanced 3-T MRI for the differentiation of infiltrative hepatocellular carcinoma and focal confluent fibrosis in liver cirrhosis |journal=Magn Reson Imaging |volume=31 |issue=7 |pages=1137–42 |year=2013 |pmid=23688409 |doi=10.1016/j.mri.2013.01.011 |url=}}</ref><ref name="pmid11906867">{{cite journal |vauthors=Brancatelli G, Federle MP, Grazioli L, Golfieri R, Lencioni R |title=Large regenerative nodules in Budd-Chiari syndrome and other vascular disorders of the liver: CT and MR imaging findings with clinicopathologic correlation |journal=AJR Am J Roentgenol |volume=178 |issue=4 |pages=877–83 |year=2002 |pmid=11906867 |doi=10.2214/ajr.178.4.1780877 |url=}}</ref><ref name="pmid12110714">{{cite journal |vauthors=Brancatelli G, Federle MP, Grazioli L, Golfieri R, Lencioni R |title=Benign regenerative nodules in Budd-Chiari syndrome and other vascular disorders of the liver: radiologic-pathologic and clinical correlation |journal=Radiographics |volume=22 |issue=4 |pages=847–62 |year=2002 |pmid=12110714 |doi=10.1148/radiographics.22.4.g02jl17847 |url=}}</ref><ref name="NewerlaSchaeffer2012">{{cite journal|last1=Newerla|first1=Caroline|last2=Schaeffer|first2=Fabienne|last3=Terracciano|first3=Luigi|last4=Hohmann|first4=Joachim|title=Multiple FNH-Like Lesions in a Patient with Chronic Budd-Chiari Syndrome: Gd-EOB-Enhanced MRI and BR1 CEUS Findings|journal=Case Reports in Radiology|volume=2012|year=2012|pages=1–5|issn=2090-6862|doi=10.1155/2012/685486}}</ref><ref name="pmid22618456">{{cite journal |vauthors=Yoneda N, Matsui O, Kitao A, Kita R, Kozaka K, Koda W, Kobayashi S, Gabata T, Ikeda H, Sato Y, Nakanuma Y |title=Hepatocyte transporter expression in FNH and FNH-like nodule: correlation with signal intensity on gadoxetic acid enhanced magnetic resonance images |journal=Jpn J Radiol |volume=30 |issue=6 |pages=499–508 |year=2012 |pmid=22618456 |doi=10.1007/s11604-012-0085-4 |url=}}</ref><ref name="MatsuiKadoya1995">{{cite journal|last1=Matsui|first1=O|last2=Kadoya|first2=M|last3=Takahashi|first3=S|last4=Yoshikawa|first4=J|last5=Gabata|first5=T|last6=Takashima|first6=T|last7=Kitagawa|first7=K|title=Focal sparing of segment IV in fatty livers shown by sonography and CT: correlation with aberrant gastric venous drainage.|journal=American Journal of Roentgenology|volume=164|issue=5|year=1995|pages=1137–1140|issn=0361-803X|doi=10.2214/ajr.164.5.7717220}}</ref><ref name="pmid10101644">{{cite journal |vauthors=Itai Y, Matsui O |title='Nonportal' splanchnic venous supply to the liver: abnormal findings on CT, US and MRI |journal=Eur Radiol |volume=9 |issue=2 |pages=237–43 |year=1999 |pmid=10101644 |doi=10.1007/s003300050661 |url=}}</ref><ref name="NicolauBr�2004">{{cite journal|last1=Nicolau|first1=C.|last2=Br�|first2=C.|title=Focal liver lesions: evaluation with contrast-enhanced ultrasonography|journal=Abdominal Imaging|volume=29|issue=3|year=2004|issn=0942-8925|doi=10.1007/s00261-003-0117-8}}</ref>
{|
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Common causes of liver mass
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Solid
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Cystic
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Association with liver disease
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Malignant potential of transformation
|-
! align="center" style="background:#DCDCDC;" + |Hepatic cellular carcinoma
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
|-
! align="center" style="background:#DCDCDC;" + |[[Cholangiocarcinoma]]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
|-
! align="center" style="background:#DCDCDC;" + |Hepatic [[Adenoma]]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | +
|-
! align="center" style="background:#DCDCDC;" + |[[Focal nodular hyperplasia]]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | -
|-
! align="center" style="background:#DCDCDC;" + |[[Hemangioma|Liver hemangioma]]
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | -
|-
! align="center" style="background:#DCDCDC;" + |Angiomyolipoma
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | -
|-
! align="center" style="background:#DCDCDC;" + |Macroregenerative/dysplastic nodule
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
|-
! align="center" style="background:#DCDCDC;" + |Fibrolemellar hepatocellular carcinoma
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | +
|-
! align="center" style="background:#DCDCDC;" + |Metastatic cancer
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | +
|-
! align="center" style="background:#DCDCDC;" + |Focal fatty infiltration and focal fat sparing
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | -
|-
! align="center" style="background:#DCDCDC;" + |Inflammatory pseudotumor
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | -
|-
! align="center" style="background:#DCDCDC;" + |Mesenchymal hamartoma
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | -
|-
! align="center" style="background:#DCDCDC;" + |Hepatic abscess
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | -
|-
! align="center" style="background:#DCDCDC;" + |Echinococcal cystic disease
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | -
|-
! align="center" style="background:#DCDCDC;" + |Simple cyst
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | -
|-
! align="center" style="background:#DCDCDC;" + |Polycystic liver disease
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | -
|-
! align="center" style="background:#DCDCDC;" + |Cyst adenoma
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | +
|-
! align="center" style="background:#DCDCDC;" + |Cyst adenocarcinoma
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | +
|-
! align="center" style="background:#DCDCDC;" + |Choledochal cysts (type IV and V)
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | +
| align="center" style="background:#F5F5F5;" + | -
| align="center" style="background:#F5F5F5;" + | +
|}
===Causes by Organ System===  
===Causes by Organ System===  
{|style="width:85%; height:90px" border="1"
{| style="width:85%; height:90px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |[[Hepatic artery aneurysm]]
| style="width:75%" bgcolor="Beige" ; border="1" |[[Hepatic artery aneurysm]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
| '''Chemical / poisoning'''
|bgcolor="Beige"|No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
| '''Dermatologic'''
|bgcolor="Beige"|No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| '''Drug Side Effect'''
|bgcolor="Beige"|No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
| '''Ear Nose Throat'''
|bgcolor="Beige"|No underlying causes
| bgcolor="Beige" |No underlying causes
|-  
|-  
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
| '''Endocrine'''
|bgcolor="Beige"|No underlying causes
| bgcolor="Beige" |No underlying causes
|-  
|-  
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Environmental'''
| '''Environmental'''
|bgcolor="Beige"|No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| '''Gastroenterologic'''
|bgcolor="Beige"|[[Choledochal cyst]]
| bgcolor="Beige" |[[Choledochal cyst]]
   
   
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Genetic'''
| '''Genetic'''
|bgcolor="Beige"|[[Klippel-Trenaunay-Weber syndrome]], [[Von Hippel-Lindau disease]], [[Osler-Weber-Rendu syndrome]], [[Autosomal dominant polycystic kidney disease]], [[Caroli disease]], [[Beckwith-Wiedemann syndrome]], [[Familial adenomatous polyposis]]
| bgcolor="Beige" |[[Klippel-Trenaunay-Weber syndrome]], [[Von Hippel-Lindau disease]], [[Osler-Weber-Rendu syndrome]], [[Autosomal dominant polycystic kidney disease]], [[Caroli disease]], [[Beckwith-Wiedemann syndrome]], [[Familial adenomatous polyposis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
| '''Hematologic'''
|bgcolor="Beige"|No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| '''Iatrogenic'''
|bgcolor="Beige"|No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
|bgcolor="Beige"|[[Amoebic liver abscess]], [[Pyogenic liver abscess]], [[Hydatid cyst]], [[Alveolar hydatid disease]], [[Pericholecystic abscess]], [[Empyema gallbladder]], [[Subhepatic abscess]], [[Subphrenic abscess]], [[Tuberculosis]]
| bgcolor="Beige" |[[Amoebic liver abscess]], [[Pyogenic liver abscess]], [[Hydatid cyst]], [[Alveolar hydatid disease]], [[Pericholecystic abscess]], [[Empyema gallbladder]], [[Subhepatic abscess]], [[Subphrenic abscess]], [[Tuberculosis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"|[[Sarcoidosis]]
| bgcolor="Beige" |[[Sarcoidosis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
| '''Neurologic'''
|bgcolor="Beige"|No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
| '''Nutritional / Metabolic'''
|bgcolor="Beige"|No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"|No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
| '''Oncologic'''
|bgcolor="Beige"|'''Benign''': [[Cystadenoma]], [[Hepatocellular adenoma]], [[Hepatic hemangioma]], [[Hepatic angiomyolipoma]], [[Hepatoblastoma]], [[Primary hepatic lymphoma]], [[Focal nodular hyperplasia]], [[Nodular regenerative hyperplasia]], [[Teratoma]], [[Autoinfarction hepatocellular adenoma]], [[Hemangioendothelioma]], [[Hepatic hamartoma]], [[Mesenchymal hamartoma of infancy]], [[Cholangioadenoma]], [[Adenolipoma]], [[Angiomyolipoma]], [[Myelolipoma]], [[Fibroma]],
| bgcolor="Beige" |'''Benign''': [[Cystadenoma]], [[Hepatocellular adenoma]], [[Hepatic hemangioma]], [[Hepatic angiomyolipoma]], [[Hepatoblastoma]], [[Primary hepatic lymphoma]], [[Focal nodular hyperplasia]], [[Nodular regenerative hyperplasia]], [[Teratoma]], [[Autoinfarction hepatocellular adenoma]], [[Hemangioendothelioma]], [[Hepatic hamartoma]], [[Mesenchymal hamartoma of infancy]], [[Cholangioadenoma]], [[Adenolipoma]], [[Angiomyolipoma]], [[Myelolipoma]], [[Fibroma]],


'''Malignant''': [[Cystadenocarcinoma]], [[Hepatocellular carcinoma]], [[Fibrolamellar carcinoma]], [[Cholangiocarcinoma]], [[Primary squamous cell carcinoma]], [[Hepatic angiosarcoma]], [[Carcinoid tumor]], [[Neuroblastoma]], [[Gallbladder cancer]], [[Wilms tumor]], [[Leiomyosarcoma]], [[Fibrosarcoma]]
'''Malignant''': [[Cystadenocarcinoma]], [[Hepatocellular carcinoma]], [[Fibrolamellar carcinoma]], [[Cholangiocarcinoma]], [[Primary squamous cell carcinoma]], [[Hepatic angiosarcoma]], [[Carcinoid tumor]], [[Neuroblastoma]], [[Gallbladder cancer]], [[Wilms tumor]], [[Leiomyosarcoma]], [[Fibrosarcoma]]
Line 81: Line 204:
'''Metastatic:''' [[Colorectal carcinoma]], [[Pancreatic ductal adenocarcinoma]], [[Oesophageal cancer]], [[gastric carcinoma]], [[gastrointestinal stromal tumor]], [[Carcinoid tumor]], [[Lung cancer]], [[Breast adenocarcinoma]], [[Ovarian cancer]], [[Endometrial cancer]], [[Renal cell carcinoma]], [[Prostate cancer]], [[Non-Hodgkins lymphoma]], [[Hodgkins lymphoma]]
'''Metastatic:''' [[Colorectal carcinoma]], [[Pancreatic ductal adenocarcinoma]], [[Oesophageal cancer]], [[gastric carcinoma]], [[gastrointestinal stromal tumor]], [[Carcinoid tumor]], [[Lung cancer]], [[Breast adenocarcinoma]], [[Ovarian cancer]], [[Endometrial cancer]], [[Renal cell carcinoma]], [[Prostate cancer]], [[Non-Hodgkins lymphoma]], [[Hodgkins lymphoma]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Opthalmologic'''
| '''Opthalmologic'''
|bgcolor="Beige"|No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
| '''Overdose / Toxicity'''
|bgcolor="Beige"|No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Psychiatric'''
| '''Psychiatric'''
|bgcolor="Beige"|No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
| '''Pulmonary'''
|bgcolor="Beige"|No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
| '''Renal / Electrolyte'''
|bgcolor="Beige"|No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"|No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Sexual'''
| '''Sexual'''
|bgcolor="Beige"|No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Trauma'''
| '''Trauma'''
|bgcolor="Beige"|[[Intrahepatic hematoma]], [[Biliary hematoma]], [[Hepatic subcapsular hematoma]]
| bgcolor="Beige" |[[Intrahepatic hematoma]], [[Biliary hematoma]], [[Hepatic subcapsular hematoma]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Urologic'''
| '''Urologic'''
|bgcolor="Beige"|No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| '''Miscellaneous'''
|bgcolor="Beige"|No underlying causes
| bgcolor="Beige" |No underlying causes
|-
|-
|}
|}
==References==
{{Reflist|2}}
[[Category:Medicine]]
[[Category:Gastroenterology]]
[[Category:Hepatology]]
[[Category:Oncology]]
[[Category:Up-To-Date]]
[[Category:Surgery]]

Latest revision as of 22:31, 29 July 2020

Liver Mass Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differential Diagnosis

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

Evaluation of Liver Mass

Staging

History and Symptoms

Physical Examination

Laboratory Studies

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Case Studies

Case #1

Liver mass causes On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Liver mass causes

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Liver mass causes

CDC on Liver mass causes

Liver mass causes in the news

Blogs on Liver mass causes

Directions to Hospitals Treating bone or soft tissue mass

Risk calculators and risk factors for Liver mass causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Nawal Muazam M.D.[2]; Suveenkrishna Pothuru, M.B,B.S. [3]; Maria Fernanda Villarreal, M.D. [4]

Overview

The most common cause of a liver mass is hepatocellular carcinoma. Common causes of benign liver mass, include: hepatic hemangioma, focal nodular hyperplasia, hepatic adenoma, idiopathic noncirrhotic portal hypertension (including nodular regenerative hyperplasia and regenerative nodules). Common causes of malignant liver masses, include: hepatocellular carcinoma, cholangiocarcinoma, and metastatic disease.

Causes

Common causes of liver mass incude:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][[#cite_note-NicolauBr�2004-31|[31]]]

Common causes of liver mass Solid Cystic Association with liver disease Malignant potential of transformation
Hepatic cellular carcinoma + - + +
Cholangiocarcinoma + - + +
Hepatic Adenoma + - - +
Focal nodular hyperplasia + - - -
Liver hemangioma + - - -
Angiomyolipoma + - - -
Macroregenerative/dysplastic nodule + - + +
Fibrolemellar hepatocellular carcinoma + - - +
Metastatic cancer + - - +
Focal fatty infiltration and focal fat sparing + - - -
Inflammatory pseudotumor + - - -
Mesenchymal hamartoma + - - -
Hepatic abscess + + - -
Echinococcal cystic disease - + - -
Simple cyst - + - -
Polycystic liver disease - + - -
Cyst adenoma - + - +
Cyst adenocarcinoma - + - +
Choledochal cysts (type IV and V) - + - +

Causes by Organ System

Cardiovascular Hepatic artery aneurysm
Chemical / poisoning No underlying causes
Dermatologic No underlying causes
Drug Side Effect No underlying causes
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic Choledochal cyst
Genetic Klippel-Trenaunay-Weber syndrome, Von Hippel-Lindau disease, Osler-Weber-Rendu syndrome, Autosomal dominant polycystic kidney disease, Caroli disease, Beckwith-Wiedemann syndrome, Familial adenomatous polyposis
Hematologic No underlying causes
Iatrogenic No underlying causes
Infectious Disease Amoebic liver abscess, Pyogenic liver abscess, Hydatid cyst, Alveolar hydatid disease, Pericholecystic abscess, Empyema gallbladder, Subhepatic abscess, Subphrenic abscess, Tuberculosis
Musculoskeletal / Ortho Sarcoidosis
Neurologic No underlying causes
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Benign: Cystadenoma, Hepatocellular adenoma, Hepatic hemangioma, Hepatic angiomyolipoma, Hepatoblastoma, Primary hepatic lymphoma, Focal nodular hyperplasia, Nodular regenerative hyperplasia, Teratoma, Autoinfarction hepatocellular adenoma, Hemangioendothelioma, Hepatic hamartoma, Mesenchymal hamartoma of infancy, Cholangioadenoma, Adenolipoma, Angiomyolipoma, Myelolipoma, Fibroma,

Malignant: Cystadenocarcinoma, Hepatocellular carcinoma, Fibrolamellar carcinoma, Cholangiocarcinoma, Primary squamous cell carcinoma, Hepatic angiosarcoma, Carcinoid tumor, Neuroblastoma, Gallbladder cancer, Wilms tumor, Leiomyosarcoma, Fibrosarcoma

Metastatic: Colorectal carcinoma, Pancreatic ductal adenocarcinoma, Oesophageal cancer, gastric carcinoma, gastrointestinal stromal tumor, Carcinoid tumor, Lung cancer, Breast adenocarcinoma, Ovarian cancer, Endometrial cancer, Renal cell carcinoma, Prostate cancer, Non-Hodgkins lymphoma, Hodgkins lymphoma

Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy No underlying causes
Sexual No underlying causes
Trauma Intrahepatic hematoma, Biliary hematoma, Hepatic subcapsular hematoma
Urologic No underlying causes
Miscellaneous No underlying causes

References

  1. Kim TK, Lee E, Jang HJ (2015). "Imaging findings of mimickers of hepatocellular carcinoma". Clin Mol Hepatol. 21 (4): 326–43. doi:10.3350/cmh.2015.21.4.326. PMC 4712159. PMID 26770920.
  2. Ferrell, Linda (2000). "Liver Pathology: Cirrhosis, Hepatitis and Primary Liver Tumors. Update and Diagnostic Problems". Modern Pathology. 13 (6): 679–704. doi:10.1038/modpathol.3880119. ISSN 0893-3952.
  3. Kim, Tae Kyoung; Lee, Eunchae; Jang, Hyun-Jung (2015). "Imaging findings of mimickers of hepatocellular carcinoma". Clinical and Molecular Hepatology. 21 (4): 326. doi:10.3350/cmh.2015.21.4.326. ISSN 2287-2728.
  4. Doo, Kyung Won; Lee, Chang Hee; Choi, Jae Woong; Lee, Jongmee; Kim, Kyeong Ah; Park, Cheol Min (2009). ""Pseudo Washout" Sign in High-Flow Hepatic Hemangioma on Gadoxetic Acid Contrast-Enhanced MRI Mimicking Hypervascular Tumor". American Journal of Roentgenology. 193 (6): W490–W496. doi:10.2214/AJR.08.1732. ISSN 0361-803X.
  5. Zech CJ, Herrmann KA, Reiser MF, Schoenberg SO (2007). "MR imaging in patients with suspected liver metastases: value of liver-specific contrast agent Gd-EOB-DTPA". Magn Reson Med Sci. 6 (1): 43–52. PMID 17510541.
  6. Cheng, H C; Tsai, S H; Chiang, J H; Chang, C Y (1995). "Hyalinized liver hemangioma mimicking malignant tumor at MR imaging". American Journal of Roentgenology. 165 (4): 1016–1017. doi:10.2214/ajr.165.4.7676959. ISSN 0361-803X.
  7. Haratake J, Horie A, Nagafuchi Y (1992). "Hyalinized hemangioma of the liver". Am. J. Gastroenterol. 87 (2): 234–6. PMID 1370873.
  8. Takayasu, K; Moriyama, N; Shima, Y; Muramatsu, Y; Yamada, T; Makuuchi, M; Yamasaki, S; Hirohashi, S (1986). "Atypical radiographic findings in hepatic cavernous hemangioma: correlation with histologic features". American Journal of Roentgenology. 146 (6): 1149–1153. doi:10.2214/ajr.146.6.1149. ISSN 0361-803X.
  9. Yamashita Y, Shimada M, Taguchi K, Gion T, Hasegawa H, Utsunomiya T, Hamatsu T, Matsumata T, Sugimachi K (2000). "Hepatic sclerosing hemangioma mimicking a metastatic liver tumor: report of a case". Surg. Today. 30 (9): 849–52. PMID 11039718.
  10. Kim, Tae Kyoung; Lee, Eunchae; Jang, Hyun-Jung (2015). "Imaging findings of mimickers of hepatocellular carcinoma". Clinical and Molecular Hepatology. 21 (4): 326. doi:10.3350/cmh.2015.21.4.326. ISSN 2287-2728.
  11. Lee, So Jung; Kim, So Yeon; Kim, Kyoung Won; Shin, Yong Moon; Kim, Hyoung Jung; Lee, Jong Seok; Kim, Sun A (2012). "Hepatic angiomyolipoma with minimal fat, mimicking hepatocellular carcinoma". Clinical and Molecular Hepatology. 18 (3): 330. doi:10.3350/cmh.2012.18.3.330. ISSN 2287-2728.
  12. Kim R, Lee JM, Joo I, Lee DH, Woo S, Han JK, Choi BI (2015). "Differentiation of lipid poor angiomyolipoma from hepatocellular carcinoma on gadoxetic acid-enhanced liver MR imaging". Abdom Imaging. 40 (3): 531–41. doi:10.1007/s00261-014-0244-4. PMID 25231411.
  13. Jeon TY, Kim SH, Lim HK, Lee WJ (2010). "Assessment of triple-phase CT findings for the differentiation of fat-deficient hepatic angiomyolipoma from hepatocellular carcinoma in non-cirrhotic liver". Eur J Radiol. 73 (3): 601–6. doi:10.1016/j.ejrad.2009.01.010. PMID 19200676.
  14. Kim, T K; Choi, B I; Han, J K; Jang, H J; Cho, S G; Han, M C (1997). "Peripheral cholangiocarcinoma of the liver: two-phase spiral CT findings". Radiology. 204 (2): 539–543. doi:10.1148/radiology.204.2.9240550. ISSN 0033-8419.
  15. Choi BI, Kim TK, Han JK (1998). "MRI of clonorchiasis and cholangiocarcinoma". J Magn Reson Imaging. 8 (2): 359–66. PMID 9562062.
  16. Guo, Le-Hang; Xu, Hui-Xiong (2015). "Contrast-Enhanced Ultrasound in the Diagnosis of Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma: Controversy over the ASSLD Guideline". BioMed Research International. 2015: 1–5. doi:10.1155/2015/349172. ISSN 2314-6133.
  17. Wilson, Stephanie R.; Kim, Tae Kyoung; Jang, Hyun-Jung; Burns, Peter N. (2007). "Enhancement Patterns of Focal Liver Masses: Discordance Between Contrast-Enhanced Sonography and Contrast-Enhanced CT and MRI". American Journal of Roentgenology. 189 (1): W7–W12. doi:10.2214/AJR.06.1060. ISSN 0361-803X.
  18. Ohtomo K, Baron RL, Dodd GD, Federle MP, Miller WJ, Campbell WL, Confer SR, Weber KM (1993). "Confluent hepatic fibrosis in advanced cirrhosis: appearance at CT". Radiology. 188 (1): 31–5. doi:10.1148/radiology.188.1.8511316. PMID 8511316.
  19. Hussain, Hero K.; Syed, Ibrahim; Nghiem, Hanh V.; Johnson, Timothy D.; Carlos, Ruth C.; Weadock, William J.; Francis, Isaac R. (2004). "T2-weighted MR Imaging in the Assessment of Cirrhotic Liver". Radiology. 230 (3): 637–644. doi:10.1148/radiol.2303020921. ISSN 0033-8419.
  20. Ohtomo K, Baron RL, Dodd GD, Federle MP, Ohtomo Y, Confer SR (1993). "Confluent hepatic fibrosis in advanced cirrhosis: evaluation with MR imaging". Radiology. 189 (3): 871–4. doi:10.1148/radiology.189.3.8234718. PMID 8234718.
  21. Brancatelli G, Baron RL, Federle MP, Sparacia G, Pealer K (2009). "Focal confluent fibrosis in cirrhotic liver: natural history studied with serial CT". AJR Am J Roentgenol. 192 (5): 1341–7. doi:10.2214/AJR.07.2782. PMID 19380559.
  22. Kelekis NL, Makri E, Vassiou A, Patsiaoura K, Spiridakis M, Dalekos GN (2004). "Confluent hepatic fibrosis as the presenting imaging sign in nonadvanced alcoholic cirrhosis". Clin Imaging. 28 (2): 124–7. doi:10.1016/S0899-7071(03)00243-2. PMID 15050225.
  23. Ooi CG, Chan KL, Peh WC, Saing H, Ngan H (1999). "Confluent hepatic fibrosis in monozygotic twins". Pediatr Radiol. 29 (1): 53–5. doi:10.1007/s002470050534. PMID 9880618.
  24. Park YS, Lee CH, Kim BH, Lee J, Choi JW, Kim KA, Ahn JH, Park CM (2013). "Using Gd-EOB-DTPA-enhanced 3-T MRI for the differentiation of infiltrative hepatocellular carcinoma and focal confluent fibrosis in liver cirrhosis". Magn Reson Imaging. 31 (7): 1137–42. doi:10.1016/j.mri.2013.01.011. PMID 23688409.
  25. Brancatelli G, Federle MP, Grazioli L, Golfieri R, Lencioni R (2002). "Large regenerative nodules in Budd-Chiari syndrome and other vascular disorders of the liver: CT and MR imaging findings with clinicopathologic correlation". AJR Am J Roentgenol. 178 (4): 877–83. doi:10.2214/ajr.178.4.1780877. PMID 11906867.
  26. Brancatelli G, Federle MP, Grazioli L, Golfieri R, Lencioni R (2002). "Benign regenerative nodules in Budd-Chiari syndrome and other vascular disorders of the liver: radiologic-pathologic and clinical correlation". Radiographics. 22 (4): 847–62. doi:10.1148/radiographics.22.4.g02jl17847. PMID 12110714.
  27. Newerla, Caroline; Schaeffer, Fabienne; Terracciano, Luigi; Hohmann, Joachim (2012). "Multiple FNH-Like Lesions in a Patient with Chronic Budd-Chiari Syndrome: Gd-EOB-Enhanced MRI and BR1 CEUS Findings". Case Reports in Radiology. 2012: 1–5. doi:10.1155/2012/685486. ISSN 2090-6862.
  28. Yoneda N, Matsui O, Kitao A, Kita R, Kozaka K, Koda W, Kobayashi S, Gabata T, Ikeda H, Sato Y, Nakanuma Y (2012). "Hepatocyte transporter expression in FNH and FNH-like nodule: correlation with signal intensity on gadoxetic acid enhanced magnetic resonance images". Jpn J Radiol. 30 (6): 499–508. doi:10.1007/s11604-012-0085-4. PMID 22618456.
  29. Matsui, O; Kadoya, M; Takahashi, S; Yoshikawa, J; Gabata, T; Takashima, T; Kitagawa, K (1995). "Focal sparing of segment IV in fatty livers shown by sonography and CT: correlation with aberrant gastric venous drainage". American Journal of Roentgenology. 164 (5): 1137–1140. doi:10.2214/ajr.164.5.7717220. ISSN 0361-803X.
  30. Itai Y, Matsui O (1999). "'Nonportal' splanchnic venous supply to the liver: abnormal findings on CT, US and MRI". Eur Radiol. 9 (2): 237–43. doi:10.1007/s003300050661. PMID 10101644.
  31. [[#cite_ref-NicolauBr�2004_31-0|↑]] Nicolau, C.; Br�, C. (2004). "Focal liver lesions: evaluation with contrast-enhanced ultrasonography". Abdominal Imaging. 29 (3). doi:10.1007/s00261-003-0117-8. ISSN 0942-8925. replacement character in |last2= at position 3 (help)