Ultrasonography

Liver & Gall Bladder

VCA 341
Dr. LeeAnn Pack
lpack@upei.ca

Liver

Indications for U/S

Ascites
Hepatomegaly/microhepatia
Cranial abdominal mass
Icterus
Metastasis check/tumor hunt
Fever of unknown origin
Biopsy

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U/S Technique

Scanhead placed directly under sternum

Often angled cranially
Almost like you are aiming for the heart
Begin in a transverse scan plan and set depth
to see the diaphragm echogenic line
Then switch to sagittal to see all the lobes

Intercostal techniques
used to further visualize liver lobes
Often used in deep chested dogs

Liver

Normal Anatomy

Size of liver
Assessed subjectively (rads are superior)

Parenchyma
Homogenous, uniform
Interrupted only by portal & hepatic veins
Portal veins have echogenic walls
Hepatic veins = black tubes
Hepatic arteries are not seen

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Normal Anatomy

Echogenicity
Dog:
Cat:

Spleen > liver > kidney

Spleen = liver > kidney

Texture
More coarse texture than spleen

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Normal Anatomy

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Normal Anatomy

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Normal Anatomy

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Normal Anatomy

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Vasculature

Portal veins
More echogenic than hepatic veins due to
surrounding fibro-fatty tissue
Less visible with PSS, fibrosis, & cirrhosis
Hepatic veins
Best seen cranially near diaphragm
(emptying into vena cava)
Walls not visible

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Vasculature

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Hepatic Congestion

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Pathology

Diffuse disease
Focal or multifocal disease

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Diffuse Disease

Often noticed with changes in echogenicity

Compare with spleen and kidney

US is least valuable for recognizing or

differentiating diffuse liver diseases
A biopsy is often necessary

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Diffuse Disease

Hypoechoic changes
Diffuse infiltration
Lymphoma
Leukemia
Amyloidosis

Passive congestion
Right heart failure also see hepatic venous
enlargement

Acute hepatitis often normal but maybe dec.

with enhancement of periportal echoes

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Diffuse Disease

Hyperechoic changes
Hepatic lipidosis (fatty infiltration)
Diabetes mellitus

Chronic hepatitis
Ascites maybe present

Fibrosis/Cirrhosis
Liver usually small

Steroid hepatopathy
Lymphosarcoma (less common)

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Diffuse Disease

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Focal Disease

Cysts
Abscess
Hematoma
Nodular hyperplasia
Hemorrhage
Necrosis
Granuloma
Neoplasia
Primary
Metastatic

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Focal Disease

Cysts
Thin, well-defined walls
No internal echos
Sharp distinct borders
Acoustic enhancement
Congenital or acquired
Oddballs
Irregular walls
Septations, debris

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Focal Disease

Cysts
Percutaneous aspiration of the cyst by US
guidance and cytologic evaluation with
bacterial culture warranted
On serial exams usually little to no change in
size
Typically an incidental finding unless polycystic
disease replaces large amt of parenchyma,
compresses other structures or cyst becomes
infected

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Hepatic Cyst

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Focal Disease

Abscess
Mixed echogenicity
Aspirate indicated

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Focal Disease

Hematoma
Mixed echogenicity echogenicity changes with
age
Acute = echogenic
Then = anechoic or hypoechoic until clot occurs
Late = clot organization - echogenic

Margins generally irregular & poorly defined

Cant differentiate from necrosis, abscess or
tumor

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Focal Disease

Nodular hyperplasia
May occur in up to 60% of older dogs
Variable appearance
Not able to differentiate with U/S alone
Biopsy indicated

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Nodule in Liver

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Neoplasia

Appearance is variable
Diffuse
Focal, multifocal

Cell type obtained by US FNA or Biopsy

Metastatic neoplasia can not be
differentiated from neoplasia, nor can the
tumor type be ascertained from the US
appearance alone

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Hepatic Neoplasia

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Shunts

Congenital Portosystemic Shunts

Patent ductus venosus
Not all intrahepatic shunts are seen (large dogs)
Shunting vessel may be seen in extrahepatic
shunts (small dogs)
Why are shunts reported in the literature to be
easy to find but they are not?
May detect a shunt but if not does not rule it
out

Gall
Bladder

Indications for U/S

Thickened wall
Stones
Mucoceles
Cholestasis
Cholecystitis
Sludge
Icterus

Gall
Bladder

U/S Technique

How to find it?

Anechoic, round to oval structure to right of
midline

Gall
Bladder

Normal Anatomy

Wall is thin echogenic line

Size of GB is variable
Cat GB is kind of bi-lobed

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Bladder

Feline Bi-lobed GB

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Bladder

Pathology

Kiwi-shaped extensions
Gallbladder mucocele

Hypoechoic areas in wall

Edema
Acute inflammation

Large, hyperechoic sediment

Gallstones usually cause acoustic shadowing

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Bladder

GB Mucocele

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Bladder

GB Mucocele

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Bladder

GB Mucocele

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Bladder

GB Mucocele + perf

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Bladder

Cholelith

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Bladder

Biliary Calculi

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Bladder

Sludge in GB

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Bladder

Thickened GB Wall

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Bladder

Pathology