Chapter 107: Liver Parenchyma, Adrenal Glands, and Abdominal Wall Imaging

(A) Longitudinal gray-scale ultrasound shows a heterogeneous echogenic hematoma (H) adjacent to the liver parenchyma (L). (B) Computed tomography (CT) confirms a subcapsular liver hematoma (arrows) indenting on the liver contour. The high attenuation on CT is quite typical of acute and subacute hematomas, allowing a confident diagnosis to be made.

(A) Transverse gray-scale ultrasound depicts a fluid collection with low-level echoes suspicious for a hematoma (H). An abscess could have a similar appearance on ultrasound. (B) Corresponding unenhanced axial CT shows central hyperattenuation consistent with a parenchyma hematoma (arrows).

(A–B) Contrast-enhanced axial CT images show lenticular-shaped subcapsular heterogenous collection indenting on the liver contour and extending caudally and medially (arrows). High attenuation, such as in this case, is typical of hematomas. Perisplenic high attenuation hemoperitoneum is also seen (asterisk.)

(A–B) Unenhanced axial consecutive CT images show an ovoid-shaped subcapsular fluid collection (H) completely encircling the lateral segment of the left lobe of the liver (arrows). Notice the higher attenuation, not expected for any collection other than a hematoma. The inferior aspect of the liver parenchyma exhibits decreased attenuation due to infarction.

(A) Longitudinal gray-scale ultrasound shows a lenticular fluid collection (H) surrounding the posterior aspect of the right lobe of the liver. Low-level echoes within the collection suggest the possibility of a hematoma. (B) Contrast-enhanced axial CT image confirms the subcapsular location of the hematoma (arrows) that also extends behind the inferior vena cava (IVC). The anterior location of the collection is a clue to differentiate this hematoma from a pleural effusion. Notice the metal material related to the IVC anastomosis. Periportal edema is also appreciated (red arrow).

(A–B) Two examples of liver infarction are shown. Liver infarction manifests typically as wedge-shaped, low-attenuation lesions that are capsular based and do not enhance. Mass effect is usually absent. Part A shows multiple peripherally located infarctions (arrows) in a patient with hepatic artery thrombosis, and Part B reveals an extensive infarction compromising a large part of the right lobe (arrows) in a patient with portal vein occlusion. Although normal liver is resistant to ischemia, in part due to its dual blood supply, transplant patients are particularly vulnerable to vascular occlusion and, especially, the bile ducts, which depend solely on the hepatic artery vascular supply. In case of bile duct necrosis, infarctions may also present as rounded or irregularly shaped central lesions that commonly progress to abscesses.