Hepatocellular adenoma differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Hepatocellular adenoma}}
[[Image:Home_logo1.png|right|250px|link=http://www.wikidoc.org/index.php/Hepatocellular_adenoma]]
{{CMG}}; {{AE}} {{ZAS}}
{{CMG}}; {{AE}} {{ZAS}}
==Overview==
==Overview==
[[hepatocellular adenoma]] must be [[Differentiate|differentiated]] from [[focal nodular hyperplasia]], large regenerative [[hyperplasia]], [[hepatocellular carcinoma]] in non [[Cirrhosis|cirrhotic]] [[Patient|patients]] and [[fibrolamellar hepatocellular carcinoma]], [[cholangiocarcinoma]], [[Lymphoma|primary lymphoma]] and [[Metastasis|metastases]] on the basis of [[clinical]] presentation and [[Magnetic resonance imaging|MRI]] findings.
Hepatocellular adenoma must be [[Differentiate|differentiated]] from [[focal nodular hyperplasia]], large regenerative [[hyperplasia]], [[hepatocellular carcinoma]] in non [[Cirrhosis|cirrhotic]] [[Patient|patients]], [[fibrolamellar hepatocellular carcinoma]], [[cholangiocarcinoma]], [[Lymphoma|primary lymphoma]], and [[Metastasis|metastases]] on the basis of [[clinical]] presentation and [[Magnetic resonance imaging|MRI]] findings.


==Hepatocellular adenoma differential diagnosis==
==Differentiating Hepatocellular Adenoma from other Diseases==
* The [[hepatocellular adenoma]] must be [[Differentiate|differentiated]] from following [[Disease|conditions]].<ref>{{Cite journal
 
 
Hepatocellular adenoma must be [[Differentiate|differentiated]] from [[focal nodular hyperplasia]], large regenerative [[hyperplasia]], hepatocellular carcinoma in non [[Cirrhosis|cirrhotic]] [[Patient|patients]], [[fibrolamellar hepatocellular carcinoma]], [[cholangiocarcinoma]], [[Lymphoma|primary lymphoma]], and [[Metastasis|metastases]] on the basis of [[clinical]] presentation and [[Magnetic resonance imaging|MRI]] findings:<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="WuSaluja2006">{{cite journal|last1=Wu|first1=Jim S.|last2=Saluja|first2=Sanjay|last3=Garcia-Tsao|first3=Guadalupe|last4=Chong|first4=Alice|last5=Henderson|first5=Katherine J.|last6=White|first6=Robert I.|title=Liver Involvement in Hereditary Hemorrhagic Telangiectasia: CT and Clinical Findings Do Not Correlate in Symptomatic Patients|journal=American Journal of Roentgenology|volume=187|issue=4|year=2006|pages=W399–W405|issn=0361-803X|doi=10.2214/AJR.05.1068}}</ref><ref name="ItaiMatsui1997">{{cite journal|last1=Itai|first1=Y|last2=Matsui|first2=O|title=Blood flow and liver imaging.|journal=Radiology|volume=202|issue=2|year=1997|pages=306–314|issn=0033-8419|doi=10.1148/radiology.202.2.9015047}}</ref><ref name="MathieuVasile1985"><nowiki>{{cite</nowiki></ref><ref name="pmid3881794">{{cite journal |vauthors=Mathieu D, Vasile N, Dibie C, Grenier P |title=Portal cavernoma: dynamic CT features and transient differences in hepatic attenuation |journal=Radiology |volume=154 |issue=3 |pages=743–8 |year=1985 |pmid=3881794 |doi=10.1148/radiology.154.3.3881794 |url=}}</ref><ref>Itai Y, Murata S, Saida Y, Minami M. Central zone and peripheral zone of the liver based on portal and hepatic arterial blood supply: imaging approach to deformity of cirrhotic liver. Jpn J Clin Radiol. 1994;39:1553–1559</ref><ref name="KimLee2011">{{cite journal|last1=Kim|first1=Tae Kyoung|last2=Lee|first2=Kyoung Ho|last3=Jang|first3=Hyun–Jung|last4=Haider|first4=Masoom A.|last5=Jacks|first5=Lindsay M.|last6=Menezes|first6=Ravi J.|last7=Park|first7=Seong Ho|last8=Yazdi|first8=Leyla|last9=Sherman|first9=Morris|last10=Khalili|first10=Korosh|title=Analysis of Gadobenate Dimeglumine–enhanced MR Findings for Characterizing Small (1–2-cm) Hepatic Nodules in Patients at High Risk for Hepatocellular Carcinoma|journal=Radiology|volume=259|issue=3|year=2011|pages=730–738|issn=0033-8419|doi=10.1148/radiol.11101549}}</ref><ref name="pmid11833870">{{cite journal |vauthors=Kim JH, Kim TK, Kim BS, Eun HW, Kim PN, Lee MG, Ha HK |title=Enhancement of hepatic hemangiomas with levovist on coded harmonic angiographic ultrasonography |journal=J Ultrasound Med |volume=21 |issue=2 |pages=141–8 |year=2002 |pmid=11833870 |doi= |url=}}</ref><ref name="BranniganBurns2004">{{cite journal|last1=Brannigan|first1=Margot|last2=Burns|first2=Peter N.|last3=Wilson|first3=Stephanie R.|title=Blood Flow Patterns in Focal Liver Lesions at Microbubble-enhanced US|journal=RadioGraphics|volume=24|issue=4|year=2004|pages=921–935|issn=0271-5333|doi=10.1148/rg.244035158}}</ref><ref name="pmid16641791">{{cite journal |vauthors=Kim TK, Jang HJ, Wilson SR |title=Benign liver masses: imaging with microbubble contrast agents |journal=Ultrasound Q |volume=22 |issue=1 |pages=31–9 |year=2006 |pmid=16641791 |doi= |url=}}</ref><ref name="JangKim2003">{{cite journal|last1=Jang|first1=Hyun-Jung|last2=Kim|first2=Tae Kyoung|last3=Lim|first3=Hyo Keun|last4=Park|first4=Sang Jae|last5=Sim|first5=Jung Suk|last6=Kim|first6=Hyae Young|last7=Lee|first7=Joo-Hyuk|title=Hepatic Hemangioma: Atypical Appearances on CT, MR Imaging, and Sonography|journal=American Journal of Roentgenology|volume=180|issue=1|year=2003|pages=135–141|issn=0361-803X|doi=10.2214/ajr.180.1.1800135}}</ref><ref>{{cite journal|doi=10.1102/1470-7330.2009.0015}}</ref><ref name="JangYu2009">{{cite journal|last1=Jang|first1=Hyun-Jung|last2=Yu|first2=Hojun|last3=Kim|first3=Tae Kyoung|title=Imaging of Focal Liver Lesions|journal=Seminars in Roentgenology|volume=44|issue=4|year=2009|pages=266–282|issn=0037198X|doi=10.1053/j.ro.2009.05.008}}</ref><ref name="JangYu2009" /><ref name="BhayanaKim2010">{{cite journal|last1=Bhayana|first1=Deepak|last2=Kim|first2=Tae Kyoung|last3=Jang|first3=Hyun-Jung|last4=Burns|first4=Peter N.|last5=Wilson|first5=Stephanie R.|title=Hypervascular Liver Masses on Contrast-Enhanced Ultrasound: The Importance of Washout|journal=American Journal of Roentgenology|volume=194|issue=4|year=2010|pages=977–983|issn=0361-803X|doi=10.2214/AJR.09.3375}}</ref><ref name="pmid21427331">{{cite journal |vauthors=Tamada T, Ito K, Yamamoto A, Sone T, Kanki A, Tanaka F, Higashi H |title=Hepatic hemangiomas: evaluation of enhancement patterns at dynamic MRI with gadoxetate disodium |journal=AJR Am J Roentgenol |volume=196 |issue=4 |pages=824–30 |year=2011 |pmid=21427331 |doi=10.2214/AJR.10.5113 |url=}}</ref><ref name="Heiken2007">{{cite journal|last1=Heiken|first1=Jay P.|title=Distinguishing benign from malignant liver tumours|journal=Cancer Imaging|volume=7|issue=Special Issue A|year=2007|pages=S1–S14|issn=1470-7330|doi=10.1102/1470-7330.2007.9084}}</ref><ref name="AlturkistanyJang2011">{{cite journal|last1=Alturkistany|first1=Samira|last2=Jang|first2=Hyun-Jung|last3=Yu|first3=Hojun|last4=Lee|first4=Kyoung Ho|last5=Kim|first5=Tae Kyoung|title=Fading hepatic hemangiomas on multiphasic CT|journal=Abdominal Radiology|volume=37|issue=5|year=2011|pages=775–780|issn=2366-004X|doi=10.1007/s00261-011-9826-6}}</ref><ref name="pmid18359914">{{cite journal |vauthors=Liu GJ, Lu MD, Xie XY, Xu HX, Xu ZF, Zheng YL, Liang JY, Wang W |title=Real-time contrast-enhanced ultrasound imaging of infected focal liver lesions |journal=J Ultrasound Med |volume=27 |issue=4 |pages=657–66 |year=2008 |pmid=18359914 |doi= |url=}}</ref><ref name="KimChoi2004">{{cite journal|last1=Kim|first1=Kyoung Won|last2=Choi|first2=Byung Ihn|last3=Park|first3=Seong Ho|last4=Kim|first4=Ah Young|last5=Koh|first5=Young Hwan|last6=Lee|first6=Hyun Ju|last7=Han|first7=Joon Koo|title=Pyogenic hepatic abscesses: distinctive features from hypovascular hepatic malignancies on contrast-enhanced ultrasound with SH U 508A; early experience|journal=Ultrasound in Medicine & Biology|volume=30|issue=6|year=2004|pages=725–733|issn=03015629|doi=10.1016/j.ultrasmedbio.2004.03.006}}</ref><ref name="pmid16641791" /><ref name="pmid17161932">{{cite journal |vauthors=Syed MA, Kim TK, Jang HJ |title=Portal and hepatic vein thrombosis in liver abscess: CT findings |journal=Eur J Radiol |volume=61 |issue=3 |pages=513–9 |year=2007 |pmid=17161932 |doi=10.1016/j.ejrad.2006.11.022 |url=}}</ref><ref name="MeniasSurabhi2008">{{cite journal|last1=Menias|first1=Christine O.|last2=Surabhi|first2=Venkateswar R.|last3=Prasad|first3=Srinivasa R.|last4=Wang|first4=Hanlin L.|last5=Narra|first5=Vamsi R.|last6=Chintapalli|first6=Kedar N.|title=Mimics of Cholangiocarcinoma: Spectrum of Disease|journal=RadioGraphics|volume=28|issue=4|year=2008|pages=1115–1129|issn=0271-5333|doi=10.1148/rg.284075148}}</ref><ref name="pmid1734701">{{cite journal |vauthors=Gollapudi P, Chejfec G, Zarling EJ |title=Spontaneous regression of hepatic pseudotumor |journal=Am. J. Gastroenterol. |volume=87 |issue=2 |pages=214–7 |year=1992 |pmid=1734701 |doi= |url=}}</ref><ref name="pmid10228516">{{cite journal |vauthors=Yoon KH, Ha HK, Lee JS, Suh JH, Kim MH, Kim PN, Lee MG, Yun KJ, Choi SC, Nah YH, Kim CG, Won JJ, Auh YH |title=Inflammatory pseudotumor of the liver in patients with recurrent pyogenic cholangitis: CT-histopathologic correlation |journal=Radiology |volume=211 |issue=2 |pages=373–9 |year=1999 |pmid=10228516 |doi=10.1148/radiology.211.2.r99ma36373 |url=}}</ref><ref name="CHEDIDKRUEL2017">{{cite journal|last1=CHEDID|first1=Marcio F.|last2=KRUEL|first2=Cleber R. P.|last3=PINTO|first3=Marcelo A.|last4=GREZZANA-FILHO|first4=Tomaz J. M.|last5=LEIPNITZ|first5=Ian|last6=KRUEL|first6=Cleber D. P.|last7=SCAFFARO|first7=Leandro A.|last8=CHEDID|first8=Aljamir D.|title=HEPATOCELLULAR CARCINOMA: DIAGNOSIS AND OPERATIVE MANAGEMENT|journal=ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)|volume=30|issue=4|year=2017|pages=272–278|issn=2317-6326|doi=10.1590/0102-6720201700040011}}</ref><ref>{{Cite journal
  | author = [[Luigi Grazioli]], [[Lucio Olivetti]], [[Giancarlo Mazza]] & [[Maria Pia Bondioni]]
  | author = [[Luigi Grazioli]], [[Lucio Olivetti]], [[Giancarlo Mazza]] & [[Maria Pia Bondioni]]
  | title = MR Imaging of Hepatocellular Adenomas and Differential Diagnosis Dilemma
  | title = MR Imaging of Hepatocellular Adenomas and Differential Diagnosis Dilemma
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  | pmid = 23606972
  | pmid = 23606972
}}</ref>
}}</ref>
* '''[[Focal nodular hyperplasia]]'''<ref>{{Cite journal
<ref>{{Cite journal
  | author = [[Lucas Maillette de Buy Wenniger]], [[Valeska Terpstra]] & [[Ulrich Beuers]]
  | author = [[Lucas Maillette de Buy Wenniger]], [[Valeska Terpstra]] & [[Ulrich Beuers]]
  | title = Focal nodular hyperplasia and hepatic adenoma: epidemiology and pathology
  | title = Focal nodular hyperplasia and hepatic adenoma: epidemiology and pathology
Line 50: Line 52:
  | doi = 10.1148/rg.241035050
  | doi = 10.1148/rg.241035050
  | pmid = 14730031
  | pmid = 14730031
}}</ref>
}}</ref><ref>{{Cite journal
** [[Focal nodular hyperplasia]] represents a [[Hyperplasia|hyperplastic]] response to localized [[vascular]] abnormality, consequently it is not a true [[benign tumor]] but a [[benign]] [[Congenital disorder|congenital]] hemartomatous [[malformation]].
** It is found in the same [[age]] group of [[Patient|patients]] as [[hepatocellular adenoma]], with a history of [[Oral contraceptive|oral contraception consumption]].
** [[Pathology|Pathologically]], [[focal nodular hyperplasia]] is usually a [[solitary]], subcapsular and nodular homogenous [[mass]].
** Unlike [[hepatocellular adenoma]], [[hemorrhage]] and [[necrosis]] are exceptional within the [[lesion]]. No [[malignant]] [[degeneration]] of [[focal nodular hyperplasia]] has been observed.
** On [[Magnetic resonance imaging|MRI]], a typical [[scar]] appears as hyperintense or hypointense stellate area, respectively on T2 and T1 weighted images, it is hypointense during [[Artery|arterial]] and [[Portal vein|portal venous]] phases and slightly hyperintense during equilibrium phase.
* '''Large regenerative [[hyperplasia]]'''<ref>{{Cite journal
  | author = [[J. T. Ames]], [[M. P. Federle]] & [[K. Chopra]]
  | author = [[J. T. Ames]], [[M. P. Federle]] & [[K. Chopra]]
  | title = Distinguishing clinical and imaging features of nodular regenerative hyperplasia and large regenerative nodules of the liver
  | title = Distinguishing clinical and imaging features of nodular regenerative hyperplasia and large regenerative nodules of the liver
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  | month = May
  | month = May
  | pmid = 8633567
  | pmid = 8633567
}}</ref>
}}</ref><ref>{{Cite journal
** It is an [[asymptomatic]] [[rare]] condition characterized by diffuse micronodular transformation of [[Liver|hepatic]] [[parenchyma]], without fibrous septa between [[Nodule (medicine)|nodules]].
** On [[Magnetic resonance imaging|MRI]] T2 images, it is isointense or slightly hypointense, whereas [[hepatocellular adenoma]] is hyperintense.
* '''[[Hepatocellular carcinoma]] in non-cirrhotic patients and [[fibrolamellar hepatocellular carcinoma]]'''<ref>{{Cite journal
  | author = [[T. Ichikawa]], [[M. P. Federle]], [[L. Grazioli]], [[J. Madariaga]], [[M. Nalesnik]] & [[W. Marsh]]
  | author = [[T. Ichikawa]], [[M. P. Federle]], [[L. Grazioli]], [[J. Madariaga]], [[M. Nalesnik]] & [[W. Marsh]]
  | title = Fibrolamellar hepatocellular carcinoma: imaging and pathologic findings in 31 recent cases
  | title = Fibrolamellar hepatocellular carcinoma: imaging and pathologic findings in 31 recent cases
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  | doi = 10.1007/s13244-012-0179-7
  | doi = 10.1007/s13244-012-0179-7
  | pmid = 22700119
  | pmid = 22700119
}}</ref>
}}</ref><ref>{{Cite journal
** These are [[rare]] [[malignant]] primary [[liver]] [[Tumor|tumors]] that arise in young healthy [[Patient|patients]] of both sexes.
** Signs of [[Cancer|malignancy]] ([[vascular]] and [[Bile duct|biliary]] [[invasion]]) is not present in [[hepatocellular adenoma]].
* '''[[Cholangiocarcinoma]]'''<ref>{{Cite journal
  | author = [[Christine Sempoux]], [[Ghalib Jibara]], [[Stephen C. Ward]], [[Cathy Fan]], [[Lihui Qin]], [[Sasan Roayaie]], [[M. Isabel Fiel]], [[Myron Schwartz]] & [[Swan N. Thung]]
  | author = [[Christine Sempoux]], [[Ghalib Jibara]], [[Stephen C. Ward]], [[Cathy Fan]], [[Lihui Qin]], [[Sasan Roayaie]], [[M. Isabel Fiel]], [[Myron Schwartz]] & [[Swan N. Thung]]
  | title = Intrahepatic cholangiocarcinoma: new insights in pathology
  | title = Intrahepatic cholangiocarcinoma: new insights in pathology
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  | doi = 10.1055/s-2004-828892
  | doi = 10.1055/s-2004-828892
  | pmid = 15192788
  | pmid = 15192788
}}</ref>
}}</ref><ref>{{Cite journal
** It is the primary [[malignancy]] arising from [[bile duct]] [[epithelium]] and is the second most common [[liver]] [[malignancy]] after [[hepatocellular carcinoma]].
** On [[Magnetic resonance imaging|MR imaging]], the [[cholangiocarcinoma]] is either hypointense or isointense relative to the normal [[liver]] on T1 weighted [[Magnetic resonance imaging|MR images]] but may range from mildly or markedly hyperintense on T2 weighted images.
* '''[[Lymphoma|Primary lymphoma]]'''<ref>{{Cite journal
  | author = [[P. Soyer]], [[B. Van Beers]], [[C. Grandin]], [[J. Pringot]] & [[M. Levesque]]
  | author = [[P. Soyer]], [[B. Van Beers]], [[C. Grandin]], [[J. Pringot]] & [[M. Levesque]]
  | title = Primary lymphoma of the liver: MR findings
  | title = Primary lymphoma of the liver: MR findings
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  | month = April
  | month = April
  | pmid = 8510487
  | pmid = 8510487
}}</ref>
}}</ref><ref>{{Cite journal
** [[Lymphoma|Primary lymphoma]] of the [[liver]] (confined to [[liver]] without involvement of [[Lymph node|lymph nodes]] or [[spleen]] or [[bone marrow]]) is very [[rare]].
** [[Hepatomegaly]], presence of [[Liver mass|hepatic mass]] or [[Mass|masses]] and [[pain]] in [[right upper quadrant]] are most frequent [[signs]] and [[symptoms]] in [[Lymphoma|primary lymphoma]].
** On [[Magnetic resonance imaging|MR imaging]], [[Lymphoma|primary lymphoma]] is generally seen as [[Homogenous|homogenously]]/[[Heterogeneous|heterogeneously]] hypointense compared to normal [[parenchyma]] on unenhanced T1 weighted images and hyperintense on T2 weighted images.
* '''[[Metastasis|Metastases]]'''<ref>{{Cite journal
  | author = [[Saravanan Namasivayam]], [[Diego R. Martin]] & [[Sanjay Saini]]
  | author = [[Saravanan Namasivayam]], [[Diego R. Martin]] & [[Sanjay Saini]]
  | title = Imaging of liver metastases: MRI
  | title = Imaging of liver metastases: MRI
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  | pmid = 21359932
  | pmid = 21359932
}}</ref>
}}</ref>
** [[Metastasis|Metastases]] are most common [[Causality|cause]] of [[malignant]] focal [[liver]] [[Lesion|lesions]].
** [[Liver]] [[Metastasis|metastases]] originate predominantly from primary [[Tumor|tumors]] localized in [[gastrointestinal tract]], by hematogenous spread, via [[portal vein]].
** On unenhanced T1 weighted images, [[Metastasis|metastases]] have low signal intensity compared to surrounding [[parenchyma]].
** On T2 sequences, the [[Lesion|lesions]] demonstrate high signal intensity, although the signal is generally lower than that typically observed in [[Hemangioma|hemangiomas]].


 
'''Abbreviations:''' '''[[RUQ]]'''= [[RUQ|Right upper quadrant]] of the [[abdomen]], '''LUQ'''= Left upper quadrant, '''LLQ'''= Left lower quadrant, '''RLQ'''= Right lower quadrant, '''[[Liver function tests|LFT]]'''= [[Liver function test]], [[Systemic inflammatory response syndrome|SIRS]]= [[Systemic inflammatory response syndrome]], '''[[ERCP]]'''= [[Endoscopic retrograde cholangiopancreatography]], '''[[IV]]'''= [[Intravenous]], '''N'''= Normal, '''[[Anti-mitochondrial antibody|AMA]]'''= [[Anti-mitochondrial antibody|Anti-mitochondrial antibodies]], '''[[LDH]]'''= [[Lactate dehydrogenase]], '''[[Gastrointestinal tract|GI]]'''= [[Gastrointestinal tract|Gastrointestinal]], '''[[Chest X-ray|CXR]]'''= [[Chest X-ray|Chest X ray]], '''[[Immunoglobulin A|IgA]]'''= [[Immunoglobulin A]], '''[[Immunoglobulin G|IgG]]'''= [[Immunoglobulin G]], '''[[Immunoglobulin M|IgM]]'''= [[Immunoglobulin M]], '''[[Computed tomography|CT]]'''= [[Computed tomography]], '''[[PMN]]'''= [[Polymorphonuclear cells]], '''[[ESR]]'''= [[Erythrocyte sedimentation rate]], '''[[CRP]]'''= [[C-reactive protein]], [[Transferrin saturation|TS]]= [[Transferrin saturation]], SF= [[Serum]] [[ferritin]], [[Superior mesenteric artery|SMA]]= [[Superior mesenteric artery]], [[Superior mesenteric vein|SMV]]= [[Superior mesenteric vein]], [[The electrocardiogram|ECG]]= [[Electrocardiogram]]
[[hepatocellular adenoma]] must be [[Differentiate|differentiated]] from [[focal nodular hyperplasia]], large regenerative [[hyperplasia]], [[hepatocellular carcinoma]] in non [[Cirrhosis|cirrhotic]] [[Patient|patients]] and [[fibrolamellar hepatocellular carcinoma]], [[cholangiocarcinoma]], [[Lymphoma|primary lymphoma]] and [[Metastasis|metastases]] on the basis of [[clinical]] presentation and [[Magnetic resonance imaging|MRI]] findings:<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="WuSaluja2006">{{cite journal|last1=Wu|first1=Jim S.|last2=Saluja|first2=Sanjay|last3=Garcia-Tsao|first3=Guadalupe|last4=Chong|first4=Alice|last5=Henderson|first5=Katherine J.|last6=White|first6=Robert I.|title=Liver Involvement in Hereditary Hemorrhagic Telangiectasia: CT and Clinical Findings Do Not Correlate in Symptomatic Patients|journal=American Journal of Roentgenology|volume=187|issue=4|year=2006|pages=W399–W405|issn=0361-803X|doi=10.2214/AJR.05.1068}}</ref><ref name="ItaiMatsui1997">{{cite journal|last1=Itai|first1=Y|last2=Matsui|first2=O|title=Blood flow and liver imaging.|journal=Radiology|volume=202|issue=2|year=1997|pages=306–314|issn=0033-8419|doi=10.1148/radiology.202.2.9015047}}</ref><ref name="MathieuVasile1985"><nowiki>{{cite</nowiki></ref><ref name="pmid3881794">{{cite journal |vauthors=Mathieu D, Vasile N, Dibie C, Grenier P |title=Portal cavernoma: dynamic CT features and transient differences in hepatic attenuation |journal=Radiology |volume=154 |issue=3 |pages=743–8 |year=1985 |pmid=3881794 |doi=10.1148/radiology.154.3.3881794 |url=}}</ref><ref>Itai Y, Murata S, Saida Y, Minami M. Central zone and peripheral zone of the liver based on portal and hepatic arterial blood supply: imaging approach to deformity of cirrhotic liver. Jpn J Clin Radiol. 1994;39:1553–1559</ref><ref name="KimLee2011">{{cite journal|last1=Kim|first1=Tae Kyoung|last2=Lee|first2=Kyoung Ho|last3=Jang|first3=Hyun–Jung|last4=Haider|first4=Masoom A.|last5=Jacks|first5=Lindsay M.|last6=Menezes|first6=Ravi J.|last7=Park|first7=Seong Ho|last8=Yazdi|first8=Leyla|last9=Sherman|first9=Morris|last10=Khalili|first10=Korosh|title=Analysis of Gadobenate Dimeglumine–enhanced MR Findings for Characterizing Small (1–2-cm) Hepatic Nodules in Patients at High Risk for Hepatocellular Carcinoma|journal=Radiology|volume=259|issue=3|year=2011|pages=730–738|issn=0033-8419|doi=10.1148/radiol.11101549}}</ref><ref name="pmid11833870">{{cite journal |vauthors=Kim JH, Kim TK, Kim BS, Eun HW, Kim PN, Lee MG, Ha HK |title=Enhancement of hepatic hemangiomas with levovist on coded harmonic angiographic ultrasonography |journal=J Ultrasound Med |volume=21 |issue=2 |pages=141–8 |year=2002 |pmid=11833870 |doi= |url=}}</ref><ref name="BranniganBurns2004">{{cite journal|last1=Brannigan|first1=Margot|last2=Burns|first2=Peter N.|last3=Wilson|first3=Stephanie R.|title=Blood Flow Patterns in Focal Liver Lesions at Microbubble-enhanced US|journal=RadioGraphics|volume=24|issue=4|year=2004|pages=921–935|issn=0271-5333|doi=10.1148/rg.244035158}}</ref><ref name="pmid16641791">{{cite journal |vauthors=Kim TK, Jang HJ, Wilson SR |title=Benign liver masses: imaging with microbubble contrast agents |journal=Ultrasound Q |volume=22 |issue=1 |pages=31–9 |year=2006 |pmid=16641791 |doi= |url=}}</ref><ref name="JangKim2003">{{cite journal|last1=Jang|first1=Hyun-Jung|last2=Kim|first2=Tae Kyoung|last3=Lim|first3=Hyo Keun|last4=Park|first4=Sang Jae|last5=Sim|first5=Jung Suk|last6=Kim|first6=Hyae Young|last7=Lee|first7=Joo-Hyuk|title=Hepatic Hemangioma: Atypical Appearances on CT, MR Imaging, and Sonography|journal=American Journal of Roentgenology|volume=180|issue=1|year=2003|pages=135–141|issn=0361-803X|doi=10.2214/ajr.180.1.1800135}}</ref><ref>{{cite journal|doi=10.1102/1470-7330.2009.0015}}</ref><ref name="JangYu2009">{{cite journal|last1=Jang|first1=Hyun-Jung|last2=Yu|first2=Hojun|last3=Kim|first3=Tae Kyoung|title=Imaging of Focal Liver Lesions|journal=Seminars in Roentgenology|volume=44|issue=4|year=2009|pages=266–282|issn=0037198X|doi=10.1053/j.ro.2009.05.008}}</ref><ref name="JangYu2009" /><ref name="BhayanaKim2010">{{cite journal|last1=Bhayana|first1=Deepak|last2=Kim|first2=Tae Kyoung|last3=Jang|first3=Hyun-Jung|last4=Burns|first4=Peter N.|last5=Wilson|first5=Stephanie R.|title=Hypervascular Liver Masses on Contrast-Enhanced Ultrasound: The Importance of Washout|journal=American Journal of Roentgenology|volume=194|issue=4|year=2010|pages=977–983|issn=0361-803X|doi=10.2214/AJR.09.3375}}</ref><ref name="pmid21427331">{{cite journal |vauthors=Tamada T, Ito K, Yamamoto A, Sone T, Kanki A, Tanaka F, Higashi H |title=Hepatic hemangiomas: evaluation of enhancement patterns at dynamic MRI with gadoxetate disodium |journal=AJR Am J Roentgenol |volume=196 |issue=4 |pages=824–30 |year=2011 |pmid=21427331 |doi=10.2214/AJR.10.5113 |url=}}</ref><ref name="Heiken2007">{{cite journal|last1=Heiken|first1=Jay P.|title=Distinguishing benign from malignant liver tumours|journal=Cancer Imaging|volume=7|issue=Special Issue A|year=2007|pages=S1–S14|issn=1470-7330|doi=10.1102/1470-7330.2007.9084}}</ref><ref name="AlturkistanyJang2011">{{cite journal|last1=Alturkistany|first1=Samira|last2=Jang|first2=Hyun-Jung|last3=Yu|first3=Hojun|last4=Lee|first4=Kyoung Ho|last5=Kim|first5=Tae Kyoung|title=Fading hepatic hemangiomas on multiphasic CT|journal=Abdominal Radiology|volume=37|issue=5|year=2011|pages=775–780|issn=2366-004X|doi=10.1007/s00261-011-9826-6}}</ref><ref name="pmid18359914">{{cite journal |vauthors=Liu GJ, Lu MD, Xie XY, Xu HX, Xu ZF, Zheng YL, Liang JY, Wang W |title=Real-time contrast-enhanced ultrasound imaging of infected focal liver lesions |journal=J Ultrasound Med |volume=27 |issue=4 |pages=657–66 |year=2008 |pmid=18359914 |doi= |url=}}</ref><ref name="KimChoi2004">{{cite journal|last1=Kim|first1=Kyoung Won|last2=Choi|first2=Byung Ihn|last3=Park|first3=Seong Ho|last4=Kim|first4=Ah Young|last5=Koh|first5=Young Hwan|last6=Lee|first6=Hyun Ju|last7=Han|first7=Joon Koo|title=Pyogenic hepatic abscesses: distinctive features from hypovascular hepatic malignancies on contrast-enhanced ultrasound with SH U 508A; early experience|journal=Ultrasound in Medicine & Biology|volume=30|issue=6|year=2004|pages=725–733|issn=03015629|doi=10.1016/j.ultrasmedbio.2004.03.006}}</ref><ref name="pmid16641791" /><ref name="pmid17161932">{{cite journal |vauthors=Syed MA, Kim TK, Jang HJ |title=Portal and hepatic vein thrombosis in liver abscess: CT findings |journal=Eur J Radiol |volume=61 |issue=3 |pages=513–9 |year=2007 |pmid=17161932 |doi=10.1016/j.ejrad.2006.11.022 |url=}}</ref><ref name="MeniasSurabhi2008">{{cite journal|last1=Menias|first1=Christine O.|last2=Surabhi|first2=Venkateswar R.|last3=Prasad|first3=Srinivasa R.|last4=Wang|first4=Hanlin L.|last5=Narra|first5=Vamsi R.|last6=Chintapalli|first6=Kedar N.|title=Mimics of Cholangiocarcinoma: Spectrum of Disease|journal=RadioGraphics|volume=28|issue=4|year=2008|pages=1115–1129|issn=0271-5333|doi=10.1148/rg.284075148}}</ref><ref name="pmid1734701">{{cite journal |vauthors=Gollapudi P, Chejfec G, Zarling EJ |title=Spontaneous regression of hepatic pseudotumor |journal=Am. J. Gastroenterol. |volume=87 |issue=2 |pages=214–7 |year=1992 |pmid=1734701 |doi= |url=}}</ref><ref name="pmid10228516">{{cite journal |vauthors=Yoon KH, Ha HK, Lee JS, Suh JH, Kim MH, Kim PN, Lee MG, Yun KJ, Choi SC, Nah YH, Kim CG, Won JJ, Auh YH |title=Inflammatory pseudotumor of the liver in patients with recurrent pyogenic cholangitis: CT-histopathologic correlation |journal=Radiology |volume=211 |issue=2 |pages=373–9 |year=1999 |pmid=10228516 |doi=10.1148/radiology.211.2.r99ma36373 |url=}}</ref><ref name="CHEDIDKRUEL2017">{{cite journal|last1=CHEDID|first1=Marcio F.|last2=KRUEL|first2=Cleber R. P.|last3=PINTO|first3=Marcelo A.|last4=GREZZANA-FILHO|first4=Tomaz J. M.|last5=LEIPNITZ|first5=Ian|last6=KRUEL|first6=Cleber D. P.|last7=SCAFFARO|first7=Leandro A.|last8=CHEDID|first8=Aljamir D.|title=HEPATOCELLULAR CARCINOMA: DIAGNOSIS AND OPERATIVE MANAGEMENT|journal=ABCD. 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'''Abbreviations:''' '''[[RUQ]]'''= Right upper quadrant of the abdomen, '''LUQ'''= Left upper quadrant, '''LLQ'''= Left lower quadrant, '''RLQ'''= Right lower quadrant, '''LFT'''= Liver function test, SIRS= [[Systemic inflammatory response syndrome]], '''[[ERCP]]'''= [[Endoscopic retrograde cholangiopancreatography]], '''IV'''= Intravenous, '''N'''= Normal, '''AMA'''= Anti mitochondrial antibodies, '''[[LDH]]'''= [[Lactate dehydrogenase]], '''GI'''= Gastrointestinal, '''CXR'''= Chest X ray, '''IgA'''= [[Immunoglobulin A]], '''IgG'''= [[Immunoglobulin G]], '''IgM'''= [[Immunoglobulin M]], '''CT'''= [[Computed tomography]], '''[[PMN]]'''= Polymorphonuclear cells, '''[[ESR]]'''= [[Erythrocyte sedimentation rate]], '''[[CRP]]'''= [[C-reactive protein]], TS= [[Transferrin saturation]], SF= Serum [[Ferritin]], SMA= [[Superior mesenteric artery]], SMV= [[Superior mesenteric vein]], ECG= [[Electrocardiogram]]
{| class="wikitable" style="border: 0px; font-size: 90%; margin: 5px;" align="center"
{| class="wikitable" style="border: 0px; font-size: 90%; margin: 5px;" align="center"
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Disease
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Disease
| colspan="13" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Clinical manifestations'''
| colspan="13" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Clinical Manifestations'''
! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Diagnosis
! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Diagnosis
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Comments
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Comments
Line 239: Line 215:
! style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal Pain
! style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal Pain
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Fever  
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Fever  
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rigors and chills
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rigors and Chills
! style="background:#4479BA; color: #FFFFFF;" align="center" |Nausea or vomiting
! style="background:#4479BA; color: #FFFFFF;" align="center" |Nausea or Vomiting
! style="background:#4479BA; color: #FFFFFF;" align="center" |Jaundice  
! style="background:#4479BA; color: #FFFFFF;" align="center" |Jaundice  
! style="background:#4479BA; color: #FFFFFF;" align="center" |Constipation
! style="background:#4479BA; color: #FFFFFF;" align="center" |Constipation
! style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
! style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
! style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
! style="background:#4479BA; color: #FFFFFF;" align="center" |Weight Loss
! style="background:#4479BA; color: #FFFFFF;" align="center" |GI bleeding
! style="background:#4479BA; color: #FFFFFF;" align="center" |GI Bleeding
! style="background:#4479BA; color: #FFFFFF;" align="center" |Hypo-
! style="background:#4479BA; color: #FFFFFF;" align="center" |Hypotension
tension
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Guarding
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Guarding
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rebound Tenderness
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rebound Tenderness
! style="background:#4479BA; color: #FFFFFF;" align="center" |Bowel sounds
! style="background:#4479BA; color: #FFFFFF;" align="center" |Bowel Sounds
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Lab Findings
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Lab Findings
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging
|-
|-
|Hepatocellular adenoma
| style="padding: 5px 5px; background: #DCDCDC;" align="center" | '''Hepatocellular adenoma'''
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | [[RUQ]]
|
!<nowiki>-</nowiki>
|
!<nowiki>-</nowiki>
|
!<nowiki>-</nowiki>
|
!<nowiki>-</nowiki>
|
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | -
|
!<nowiki>-</nowiki>
|
!<nowiki>-</nowiki>
|
!<nowiki>+</nowiki>
|
!<nowiki>+</nowiki>
|
!<nowiki>-</nowiki>
|
!<nowiki>-</nowiki>
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|
* Normal
|
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
|
* Normal [[liver function tests]]
* Normal [[Tumor markers|serum tumor markers]]
* Normal [[serum]] [[Alpha-fetoprotein|alpha fetoprotein]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
* [[Ultrasound|US]]
* [[Computed tomography|CT scan]]
* [[Magnetic resonance imaging|MRI]]
* [[Biopsy|Excision biopsy]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
* Associated with [[Oral contraceptive|oral contraceptive use]] in women and [[anabolic]] [[androgenic]] [[steroids]] use in men
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''[[Hepatocellular carcinoma]]/[[Metastasis]]'''
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''[[Hepatocellular carcinoma]]/[[Metastasis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −  
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Normal
* Normal
* Hyperactive if obstruction present
*[[Hyperactivity|Hyperactive]] if [[obstruction]] is present
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* High levels of [[Alpha-fetoprotein|AFP]] in serum
* High levels of [[Alpha-fetoprotein|AFP]] in [[serum]]
* Abnormal [[Liver function test|liver function tests]]
* Abnormal [[Liver function test|liver function tests]]
*[[Thrombocytopenia]]
*[[Thrombocytopenia]]
Line 298: Line 282:
* [[Liver biopsy]]
* [[Liver biopsy]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
Other symptoms:
Other [[Symptom|symptoms]]:
* [[Splenomegaly]]
* [[Splenomegaly]]
* [[Variceal bleeding]]
* [[Variceal bleeding]]
Line 307: Line 291:
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cholangiocarcinoma]]
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cholangiocarcinoma]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Elevated [[CA-19-9|CA 19-9]]
* Elevated [[CA-19-9|CA 19-9]]
* Increased [[amylase]] / [[lipase]]
* Increased [[amylase]]/[[lipase]]
* Increased [[Steatorrhea|stool fat]] content
* Increased [[Steatorrhea|stool fat]] content
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Contrast-enhanced ultrasound]]  
*[[Contrast-enhanced ultrasound]]
*[[Computed tomography|CT scan]]
*[[Computed tomography|CT scan]] findings:
**[[Calcification]]
**[[Calcification]]
**[[Pseudocyst]]  
**[[Pseudocyst]]
**Dilation of main pancreatic duct
**[[Dilation]] of main [[pancreatic duct]]
*[[Magnetic resonance imaging|MRI]]
*[[Magnetic resonance imaging|MRI]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Predisposes to pancreatic cancer
* Predisposes to [[pancreatic cancer]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pancreatic carcinoma]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pancreatic carcinoma]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Mid[[Epigastric]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Mid[[Epigastric]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
* Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* ↑ [[Alkaline phosphatase]]
* ↑ [[Alkaline phosphatase]]
Line 353: Line 339:
* ↑ [[CA-19-9|CA 19-9]]  
* ↑ [[CA-19-9|CA 19-9]]  
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Computed tomography|MDCT]] with   [[Positron emission tomography|PET]]/[[Computed tomography|CT]]
* [[Computed tomography|MDCT]] with [[Positron emission tomography|PET]]/[[Computed tomography|CT]]
* MRI
*[[Magnetic resonance imaging|MRI]]
* [[Endoscopic ultrasound|EUS]]
* [[Endoscopic ultrasound|EUS]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
Line 365: Line 351:
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Focal nodular hyperplasia]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Focal nodular hyperplasia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Normal Liver function tests
* Normal
* Normal AFP
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*Minor elevations of
* Normal [[liver function tests]]
**[[Aspartate]]  
* Normal [[Alpha-fetoprotein|AFP]]
*Minor elevations of:
**[[Aspartate]]
**[[Alanine aminotransferase]]
**[[Alanine aminotransferase]]
**[[Alkaline phosphatase]]
**[[Alkaline phosphatase]]
**[[Gamma glutamyl transpeptidase]]  
**[[Gamma glutamyl transpeptidase]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Us
*[[Ultrasound]]
* Multiphasic [[helical CT scan]]  
* Multi-phasic [[helical CT scan]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Open [[biopsy]] if diagnosis can not be established
* Open [[biopsy]] if [[diagnosis]] can not be established
|-
|-
! style="background:#4479BA; color: #FFFFFF;" align="center" |Disease
! style="background:#4479BA; color: #FFFFFF;" align="center" |Disease
! style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal Pain
! style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal Pain
! style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
! style="background:#4479BA; color: #FFFFFF;" align="center" |Fever
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rigors and chills
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rigors and Chills
! style="background:#4479BA; color: #FFFFFF;" align="center" |Nausea or vomiting
! style="background:#4479BA; color: #FFFFFF;" align="center" |Nausea or Vomiting
! style="background:#4479BA; color: #FFFFFF;" align="center" |Jaundice
! style="background:#4479BA; color: #FFFFFF;" align="center" |Jaundice
! style="background:#4479BA; color: #FFFFFF;" align="center" |Constipation
! style="background:#4479BA; color: #FFFFFF;" align="center" |Constipation
! style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
! style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea
! style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss
! style="background:#4479BA; color: #FFFFFF;" align="center" |Weight Loss
! style="background:#4479BA; color: #FFFFFF;" align="center" |GI bleeding
! style="background:#4479BA; color: #FFFFFF;" align="center" |GI Bleeding
! style="background:#4479BA; color: #FFFFFF;" align="center" |Hypo-
! style="background:#4479BA; color: #FFFFFF;" align="center" |Hypotension
tension
! style="background:#4479BA; color: #FFFFFF;" align="center" |Guarding
! style="background:#4479BA; color: #FFFFFF;" align="center" |Guarding
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rebound Tenderness
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rebound Tenderness
! style="background:#4479BA; color: #FFFFFF;" align="center" |Bowel sounds
! style="background:#4479BA; color: #FFFFFF;" align="center" |Bowel Sounds
! style="background:#4479BA; color: #FFFFFF;" align="center" |Lab Findings
! style="background:#4479BA; color: #FFFFFF;" align="center" |Lab Findings
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging
Line 412: Line 398:
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gallbladder cancer]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gallbladder cancer]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Mid[[Epigastric|epigastric]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Mid[[Epigastric|epigastric]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* ↑ [[Alkaline phosphatase]]
* ↑ [[Alkaline phosphatase]]
Line 429: Line 416:
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Ultrasonography|US]]
* [[Ultrasonography|US]]
* CT
*[[Computed tomography|CT]]
* MRI
*[[Magnetic resonance imaging|MRI]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Liver hemangioma]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Liver hemangioma]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Intermittent [[RUQ]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Intermittent [[RUQ]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>−</nowiki>
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>−</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Abnormal LFTs
* Abnormal [[Liver function tests|LFTs]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* US
*[[Ultrasound]]
* [[Single photon emission computed tomography|Single-photon emission computerized tomography(SPECT]])
*[[Single photon emission computed tomography|Single-photon emission computerized tomography (SPECT]])
* MRI
*[[Magnetic resonance imaging|MRI]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* US will reveal hypoechoic [[lesions]]
*[[Ultrasound]] will reveal hypoechoic [[lesions]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Liver abscess]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Liver abscess]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |RUQ
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |RUQ
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Hypoalbuminemia
* Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
*[[Hypoalbuminemia]]
* Abnormal [[Liver function test|liver function tests]]
* Abnormal [[Liver function test|liver function tests]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* US
*[[Ultrasound]]
* CT
*[[Computed tomography|CT]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cirrhosis|Cirrhosis]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cirrhosis|Cirrhosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]+Bloating
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]] +[[Bloating]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Hypoalbuminemia]]
*[[Hypoalbuminemia]]
* Prolonged PT
* Prolonged [[Prothrombin time|PT]]
* Abnormal LFTs
* Abnormal [[Liver function tests|LFTs]]
* [[Hyponatremia]]
*[[Hyponatremia]]
* [[Thrombocytopenia]]
*[[Thrombocytopenia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |US
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Nodular, shrunken liver
* [[Ultrasound]] findings:
* [[Ascites]]
 
**[[Nodule (medicine)|Nodular]] and shrunken [[liver]]
**[[Ascites]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Stigmata of liver disease
* Stigmata of [[liver disease]]
* Cruveilhier- Baumgarten murmur
*[[Cruveilhier-Baumgarten murmur|Cruveilhier- Baumgarten murmur]]
|- style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|- style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Inflammatory lesions
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Inflammation|Inflammatory]] [[Lesion|lesions]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>−</nowiki>
! style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>−</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
! style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Hypoalbuminemia]]
*[[Hypoalbuminemia]]
* Prolonged PT
* Prolonged [[Prothrombin time|PT]]
* Abnormal LFTs
* Abnormal [[Liver function tests|LFTs]]
* [[Hyponatremia]]
*[[Hyponatremia]]
* [[Thrombocytopenia]]
*[[Thrombocytopenia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |US
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Nodular,shrunken or coarse liver
* [[Ultrasound]] findings:
 
**[[Nodule (medicine)|Nodular]], shrunken, or coarse [[liver]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Stigmata of liver disease
* Stigmata of liver disease

Latest revision as of 16:19, 20 August 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Zahir Ali Shaikh, MD[2]

Overview

Hepatocellular adenoma must be differentiated from focal nodular hyperplasia, large regenerative hyperplasia, hepatocellular carcinoma in non cirrhotic patients, fibrolamellar hepatocellular carcinoma, cholangiocarcinoma, primary lymphoma, and metastases on the basis of clinical presentation and MRI findings.

Differentiating Hepatocellular Adenoma from other Diseases

Hepatocellular adenoma must be differentiated from focal nodular hyperplasia, large regenerative hyperplasia, hepatocellular carcinoma in non cirrhotic patients, fibrolamellar hepatocellular carcinoma, cholangiocarcinoma, primary lymphoma, and metastases on the basis of clinical presentation and MRI findings:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][16][17][18][19][20][21][22][13][23][24][25][26][27][28] [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]

Abbreviations: RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti-mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum ferritin, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram

Disease Clinical Manifestations Diagnosis Comments
Symptoms Signs
Abdominal Pain Fever Rigors and Chills Nausea or Vomiting Jaundice Constipation Diarrhea Weight Loss GI Bleeding Hypotension Guarding Rebound Tenderness Bowel Sounds Lab Findings Imaging
Hepatocellular adenoma RUQ - - - - - - - + + - -
  • Normal
Hepatocellular carcinoma/Metastasis RUQ + − + + + + + + + − +

Other symptoms:

Cholangiocarcinoma RUQ + − + + − − + − − − +
  • Normal
Pancreatic carcinoma MidEpigastric − − + + + − + − − − +
  • Normal

Skin manifestations may include:

Focal nodular hyperplasia Diffuse ± − − ± − − + + − − −
  • Normal
Disease Abdominal Pain Fever Rigors and Chills Nausea or Vomiting Jaundice Constipation Diarrhea Weight Loss GI Bleeding Hypotension Guarding Rebound Tenderness Bowel Sounds Lab Findings Imaging Comments
Gallbladder cancer Midepigastric − − + + − + + − − − −
  • Normal
Liver hemangioma Intermittent RUQ − − + + − − − − − − −
  • Normal
Liver abscess RUQ + − + + − − + − − − −
  • Normal
Cirrhosis RUQ +Bloating + − + + − − + − − − −
  • Normal
Inflammatory lesions RUQ ± − + + − − − − − − −
  • Normal
  • Stigmata of liver disease

References

  1. ↑ Choi BI, Kim TK, Han JK (1998). "MRI of clonorchiasis and cholangiocarcinoma". J Magn Reson Imaging. 8 (2): 359–66. PMID 9562062.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
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  7. ↑ {{cite
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  10. ↑ Kim, Tae Kyoung; Lee, Kyoung Ho; Jang, Hyun–Jung; Haider, Masoom A.; Jacks, Lindsay M.; Menezes, Ravi J.; Park, Seong Ho; Yazdi, Leyla; Sherman, Morris; Khalili, Korosh (2011). "Analysis of Gadobenate Dimeglumine–enhanced MR Findings for Characterizing Small (1–2-cm) Hepatic Nodules in Patients at High Risk for Hepatocellular Carcinoma". Radiology. 259 (3): 730–738. doi:10.1148/radiol.11101549. ISSN 0033-8419.
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  14. ↑ Jang, Hyun-Jung; Kim, Tae Kyoung; Lim, Hyo Keun; Park, Sang Jae; Sim, Jung Suk; Kim, Hyae Young; Lee, Joo-Hyuk (2003). "Hepatic Hemangioma: Atypical Appearances on CT, MR Imaging, and Sonography". American Journal of Roentgenology. 180 (1): 135–141. doi:10.2214/ajr.180.1.1800135. ISSN 0361-803X.
  15. ↑ . doi:10.1102/1470-7330.2009.0015. Missing or empty |title= (help)
  16. ↑ 16.0 16.1 Jang, Hyun-Jung; Yu, Hojun; Kim, Tae Kyoung (2009). "Imaging of Focal Liver Lesions". Seminars in Roentgenology. 44 (4): 266–282. doi:10.1053/j.ro.2009.05.008. ISSN 0037-198X.
  17. ↑ Bhayana, Deepak; Kim, Tae Kyoung; Jang, Hyun-Jung; Burns, Peter N.; Wilson, Stephanie R. (2010). "Hypervascular Liver Masses on Contrast-Enhanced Ultrasound: The Importance of Washout". American Journal of Roentgenology. 194 (4): 977–983. doi:10.2214/AJR.09.3375. ISSN 0361-803X.
  18. ↑ Tamada T, Ito K, Yamamoto A, Sone T, Kanki A, Tanaka F, Higashi H (2011). "Hepatic hemangiomas: evaluation of enhancement patterns at dynamic MRI with gadoxetate disodium". AJR Am J Roentgenol. 196 (4): 824–30. doi:10.2214/AJR.10.5113. PMID 21427331.
  19. ↑ Heiken, Jay P. (2007). "Distinguishing benign from malignant liver tumours". Cancer Imaging. 7 (Special Issue A): S1–S14. doi:10.1102/1470-7330.2007.9084. ISSN 1470-7330.
  20. ↑ Alturkistany, Samira; Jang, Hyun-Jung; Yu, Hojun; Lee, Kyoung Ho; Kim, Tae Kyoung (2011). "Fading hepatic hemangiomas on multiphasic CT". Abdominal Radiology. 37 (5): 775–780. doi:10.1007/s00261-011-9826-6. ISSN 2366-004X.
  21. ↑ Liu GJ, Lu MD, Xie XY, Xu HX, Xu ZF, Zheng YL, Liang JY, Wang W (2008). "Real-time contrast-enhanced ultrasound imaging of infected focal liver lesions". J Ultrasound Med. 27 (4): 657–66. PMID 18359914.
  22. ↑ Kim, Kyoung Won; Choi, Byung Ihn; Park, Seong Ho; Kim, Ah Young; Koh, Young Hwan; Lee, Hyun Ju; Han, Joon Koo (2004). "Pyogenic hepatic abscesses: distinctive features from hypovascular hepatic malignancies on contrast-enhanced ultrasound with SH U 508A; early experience". Ultrasound in Medicine & Biology. 30 (6): 725–733. doi:10.1016/j.ultrasmedbio.2004.03.006. ISSN 0301-5629.
  23. ↑ Syed MA, Kim TK, Jang HJ (2007). "Portal and hepatic vein thrombosis in liver abscess: CT findings". Eur J Radiol. 61 (3): 513–9. doi:10.1016/j.ejrad.2006.11.022. PMID 17161932.
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  28. ↑ Luigi Grazioli, Lucio Olivetti, Giancarlo Mazza & Maria Pia Bondioni (2013). "MR Imaging of Hepatocellular Adenomas and Differential Diagnosis Dilemma". International journal of hepatology. 2013: 374170. doi:10.1155/2013/374170. PMID 23606972.
  29. ↑ Lucas Maillette de Buy Wenniger, Valeska Terpstra & Ulrich Beuers (2010). "Focal nodular hyperplasia and hepatic adenoma: epidemiology and pathology". Digestive surgery. 27 (1): 24–31. doi:10.1159/000268404. PMID 20357448.
  30. ↑ Christian Grieser, Ingo G. Steffen, Daniel Seehofer, Incken-Birthe Kramme, Robert Uktolseya, Christian Scheurig-Muenkler, Bernd Hamm & Timm Denecke (2013). "Histopathologically confirmed focal nodular hyperplasia of the liver: gadoxetic acid-enhanced MRI characteristics". Magnetic resonance imaging. 31 (5): 755–760. doi:10.1016/j.mri.2012.11.006. PMID 23219272. Unknown parameter |month= ignored (help)
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  32. ↑ J. T. Ames, M. P. Federle & K. Chopra (2009). "Distinguishing clinical and imaging features of nodular regenerative hyperplasia and large regenerative nodules of the liver". Clinical radiology. 64 (12): 1190–1195. doi:10.1016/j.crad.2009.07.015. PMID 19913129. Unknown parameter |month= ignored (help)
  33. ↑ Giovanni Morana, Luigi Grazioli, Miles A. Kirchin, Maria Pia Bondioni, Niccolo Faccioli, Alessandro Guarise & Gunther Schneider (2011). "Solid hypervascular liver lesions: accurate identification of true benign lesions on enhanced dynamic and hepatobiliary phase magnetic resonance imaging after gadobenate dimeglumine administration". Investigative radiology. 46 (4): 225–239. doi:10.1097/RLI.0b013e3181feee3a. PMID 21102346. Unknown parameter |month= ignored (help)
  34. ↑ I. R. Wanless (1990). "Micronodular transformation (nodular regenerative hyperplasia) of the liver: a report of 64 cases among 2,500 autopsies and a new classification of benign hepatocellular nodules". Hepatology (Baltimore, Md.). 11 (5): 787–797. PMID 2189821. Unknown parameter |month= ignored (help)
  35. ↑ I. R. Wanless (1996). "Nodular regenerative hyperplasia, dysplasia, and hepatocellular carcinoma". The American journal of gastroenterology. 91 (5): 836–837. PMID 8633567. Unknown parameter |month= ignored (help)
  36. ↑ T. Ichikawa, M. P. Federle, L. Grazioli, J. Madariaga, M. Nalesnik & W. Marsh (1999). "Fibrolamellar hepatocellular carcinoma: imaging and pathologic findings in 31 recent cases". Radiology. 213 (2): 352–361. doi:10.1148/radiology.213.2.r99nv31352. PMID 10551212. Unknown parameter |month= ignored (help)
  37. ↑ Jose Traila Campos, Claude B. Sirlin & Jin-Young Choi (2012). "Focal hepatic lesions in Gd-EOB-DTPA enhanced MRI: the atlas". Insights into imaging. 3 (5): 451–474. doi:10.1007/s13244-012-0179-7. PMID 22700119. Unknown parameter |month= ignored (help)
  38. ↑ Christine Sempoux, Ghalib Jibara, Stephen C. Ward, Cathy Fan, Lihui Qin, Sasan Roayaie, M. Isabel Fiel, Myron Schwartz & Swan N. Thung (2011). "Intrahepatic cholangiocarcinoma: new insights in pathology". Seminars in liver disease. 31 (1): 49–60. doi:10.1055/s-0031-1272839. PMID 21344350. Unknown parameter |month= ignored (help)
  39. ↑ Nathalie Guedj, Pierre Bedossa & Valerie Paradis (2010). "[Pathology of cholangiocarcinoma]". Annales de pathologie. 30 (6): 455–463. doi:10.1016/j.annpat.2010.10.004. PMID 21167432. Unknown parameter |month= ignored (help)
  40. ↑ Y. Maetani, K. Itoh, C. Watanabe, T. Shibata, F. Ametani, H. Yamabe & J. Konishi (2001). "MR imaging of intrahepatic cholangiocarcinoma with pathologic correlation". AJR. American journal of roentgenology. 176 (6): 1499–1507. doi:10.2214/ajr.176.6.1761499. PMID 11373220. Unknown parameter |month= ignored (help)
  41. ↑ Riccardo Manfredi, Brunella Barbaro, Gabriele Masselli, Amorino Vecchioli & Pasquale Marano (2004). "Magnetic resonance imaging of cholangiocarcinoma". Seminars in liver disease. 24 (2): 155–164. doi:10.1055/s-2004-828892. PMID 15192788. Unknown parameter |month= ignored (help)
  42. ↑ P. Soyer, B. Van Beers, C. Grandin, J. Pringot & M. Levesque (1993). "Primary lymphoma of the liver: MR findings". European journal of radiology. 16 (3): 209–212. PMID 8508837. Unknown parameter |month= ignored (help)
  43. ↑ E. S. Zafrani & P. Gaulard (1993). "Primary lymphoma of the liver". Liver. 13 (2): 57–61. PMID 8510487. Unknown parameter |month= ignored (help)
  44. ↑ Saravanan Namasivayam, Diego R. Martin & Sanjay Saini (2007). "Imaging of liver metastases: MRI". Cancer imaging : the official publication of the International Cancer Imaging Society. 7: 2–9. doi:10.1102/1470-7330.2007.0002. PMID 17293303.
  45. ↑ Daichi Hayashi, Jaroslaw N. Tkacz, Stephen Hammond, Brooke C. Devenney-Cakir, Souhil Zaim, Nadia Bouzegaou, Souhila Ounadjela & Ali Guermazi (2011). "Gastroenteropancreatic neuroendocrine tumors: multimodality imaging features with pathological correlation". Japanese journal of radiology. 29 (2): 85–91. doi:10.1007/s11604-010-0522-1. PMID 21359932. Unknown parameter |month= ignored (help)


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