GI Radiography


Case 19 :
Patient presents with dull lower abdominal pain. All routine tests are within normal limits.
What is the USG diagnosis?
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Diagnosis:

Hepatic Pseudotumor

Discussion:

Although representing a frequent pattern in metastases and mycotic abscesses, a central hyperechoic core encircled by a hypoechoic halo has not been commonly reported in relation to pseudotumors. Whereas multifocal target lesions in the liver suggest metastases or mycotic abscesses, an isolated target lesion in the fourth hepatic segment requires a differential diagnostic approach and a pseudotumor should be suspected because of its clinical relevance.

The anteromedial edge of segment IV of the liver, adjacent to the falciform ligament, is a well recognized site for pseudolesions demonstrated on CT arterioportography. Focal fatty infiltration is also occasionally observed in this area. The aetiology of focal fatty infiltration in this area is also not clear. Demonstration of flow within the paraumbilical vein directly connecting to the hepatic parenchyma around the falciform ligament by colour and/or power Doppler ultrasound confirms that the portal perfusion defect seen on CTAP is a pseudolesion caused by this venous drainage without resorting to an invasive procedure



Dr. Richa Dixit, MD, Chandigarh