ARRS Case of the Week

GASTROINTESTINAL IMAGING: Liver

Case Author: Cynthia Santillian, MD, University of California, San Diego

History

56-year-old man with chronic liver disease.

Imaging Findings

Axial T2-weighted MR image of the abdomen (A) shows diffuse nodularity of the liver and enlargement of the spleen. Axial gadolinium-enhanced T1-weighted fat-suppressed MR images (B–D) show enlargement of the fissure for the ligamentum venosum (arrow, B), a right posterior hepatic notch (arrow, C), and varices (arrows, D).

Diagnosis

Cirrhosis related to hepatitis C virus infection

Teaching Points

Alcoholic cirrhosis is often associated with enlargement of the caudate lobe and hypertrophy of the left lateral segment.

Primary sclerosing cholangitis typically causes hypertrophy of the caudate lobe and atrophy of the periphery of the liver.

Portosystemic collateral vessels, such as esophageal and gastric varices, recanalized paraumbilical veins, and splenorenal collaterals are indicative of portal hypertension. Esophageal varices greater than 2–3 mm in diameter are associated with increased risk of hemorrhage.

Suggested Reading

Brancatelli G, Federle MP, Ambrosini R, et al. Cirrhosis: CT and MR imaging evaluation. Eur J Radiol 2007; 61:57–69

Kim YJ, Raman SS, Yu NC, To’o KJ, Jutabha R, Lu DS. Esophageal varices in cirrhotic patients: evaluation with liver CT. AJR 2007; 188:139–144

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