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Ultrasonographic images of hepatic hepatoblastoma: there is an ill-defined heterogeneous mass, involving almost completely the right lobe, which shows hyper-and isoechoic areas (a-c); many internal vessels are identified at colour-Doppler image (d)
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Ultrasound scan is a painless and radiation-free imaging modality and, therefore, it is widely considered the first-choice diagnostic tool in the setting of hepatopathies in paediatric patients. This article focuses on the normal ultrasound anatomy of the liver in neonatal and paediatric age and reviews the ultrasound appearance of the most common...
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... An increase in frequency of the probe increases the spatial resolution of the image but decreases the penetration of the ultrasound waves. Different frequencies might be used for different purposes such as higher frequencies being used for children since they have a thin abdominal wall and thinner subcutaneous tissue than adults [46,47]. Differential use of frequencies for adults and children has been reported in studies in the review [48], however the reporting of different frequencies was not always clear. ...
Background
Abdominal ultrasound imaging is an important method for hepatic schistosomiasis diagnosis and staging. Several ultrasound staging systems have been proposed, each attempting to standardise schistosomal periportal fibrosis (PPF) diagnosis. This review aims to establish the role of ultrasound in the diagnosis and staging of schistosomal PPF, and to map the evolution of ultrasound staging systems over time, focusing on internal validation and external reproducibility.
Methods
A systematic search was undertaken on 21 st December 2022 considering the following databases: PubMed/MEDLINE (1946-present), Embase (1974-present), Global Health (1973-present), Global Index Medicus (1901-present), and Web of Science Core Collection–Science Citation Index Expanded (1900-present) and the Cochrane Central Register of Controlled Trials (1996-present). Case reports, systematic reviews and meta-analyses, and studies exclusively using transient or shear-wave elastography were excluded. Variables extracted included study design, study population, schistosomal PPF characteristics, and diagnostic methods. The PRISMA-ScR (2018) guidelines were followed to inform the structure of the scoping analysis.
Results
The initial search yielded 573 unique articles, of which 168 were removed after screening titles and abstracts, 43 were not retrieved due to full texts not being available online or through inter-library loans, and 170 were excluded during full text review. There were 192 remaining studies eligible for extraction. Of the extracted studies, 61.8% (76/123) of studies that reported study year were conducted after the year 2000. Over half of all extracted studies (59.4%; 114/192) were conducted in Brazil (26.0%; 50/192), China (18.8%; 36/192) or Egypt (14.6%; 28/192). For the species of schistosome considered, 77.6% (149/192) of studies considered S . mansoni and 21.4% (41/192) of studies considered S . japonicum . The ultrasound staging systems used took on three forms: measurement-based, feature-based and image pattern-based. The Niamey protocol, a measurement and image pattern-based system, was the most used among the staging systems (32.8%; 63/192), despite being the most recently proposed in 1996. The second most used was the Cairo protocol (20.8%; 40/192). Of the studies using the Niamey protocol, 77.8% (49/63) only used the image patterns element. Where ultrasound technology was specified, studies after 2000 were more likely to use convex transducers (43.4%; 33/76) than studies conducted before 2000 (32.7%; 16/49). Reporting on ultrasound-based hepatic diagnoses and their association with clinical severity was poor. Just over half of studies (56.2%; 108/192) reported the personnel acquiring the ultrasound images. A small number (9.4%; 18/192) of studies detailed their methods of image quality assurance, and 13.0% (25/192) referenced, discussed or quantified the inter- or intra-observer variation of the staging system that was used.
Conclusions
The exclusive use of the image patterns in many studies despite lack of specific acquisition guidance, the increasing number of studies over time that conduct ultrasound staging of schistosomal PPF, and the advances in ultrasound technology used since 2000 all indicate a need to consider an update to the Niamey protocol. The protocol update should simplify and prioritise what is to be assessed, advise on who is to conduct the ultrasound examination, and procedures for improved standardisation and external reproducibility.
... Patients who had at least one of the following US features were deemed as having abnormal US findings: increased and/or heterogeneous echogenicity, irregular margins, nodularity, portal hypertension (splenomegaly, increased thickness of the lesser omentum, spontaneous splenorenal anastomosis, large collateral veins, ascites, which is the accumulation of fluid in the abdomen surrounding the liver, spleen, and stomach), and biliary abnormality (bile duct dilatation) [17]. Hepatosteatosis on US was defined as bright, markedly hyperechoic liver parenchyma compared to the adjacent renal cortex and accepted as an abnormal US finding [20]. ...
Liver involvement is an important cause of morbidity and mortality in patients with cystic fibrosis (CF). While liver biopsy is the gold standard for demonstrating involvement, its invasiveness prompts a search for noninvasive alternatives.
To evaluate liver involvement in pediatric patients with CF (versus healthy controls) using magnetic resonance (MR) elastography/spectroscopy and to correlate the imaging findings with clinical/laboratory characteristics.
This was a single-center, prospective cross-sectional study conducted between April 2020 and March 2022 in patients with CF versus healthy controls. Patients with CF were divided into two subgroups: those with CF-related liver disease and those without. MR images were acquired on a 1.5-tesla machine. Kilopascal (kPa) values were derived from processing MR elastography images. MR spectroscopy was used to measure liver fat fraction, as an indication of hepatosteatosis. Groups were compared using either the Student’s t test or the Mann‒Whitney U test. The chi-square test or Fisher’s exact test were used to compare qualitative variables.
Fifty-one patients with CF (12 ± 3.3 years, 32 boys) and 24 healthy volunteers (11.1 ± 2.4 years, 15 boys) were included in the study. Median liver stiffness (P=0.003) and fat fraction (P=0.03) were higher in the CF patients than in the controls. Median liver stiffness values were higher in CF patients with CF-related liver disease than in those without CF-related liver disease (P=0.002). Liver stiffness values of CF patients with high alanine aminotransferase (ALT), high gamma-glutamyl transferase, and thrombocytopenia were found to be higher than those without (P=0.004, P<0.001, P<0.001, respectively). Only the high ALT group showed a high fat fraction (P=0.002).
Patients with CF had higher liver stiffness than the control group, and patients with CF-related liver disease had higher liver stiffness than both the CF patients without CF-related liver disease and the control group. Patients with CF had a higher fat fraction than the control group. Noninvasive assessment of liver involvement using MR elastography/spectroscopy can support the diagnosis of CF-related liver disease and the follow-up of patients with CF.
... 3.15±0.72 cm, this agree with Di Serafino M et al (21) , that mentioned the longitudinal dimensions of right lobe of liver in the same ages was 6.4 cm. ...
... Туморът е добре кръвоснабден от а. hepatica. Възможно е да има хипоехогенно периферно хало, дължащо се на капсула [32]. При деца се среща изключително рядко с честота 0.5-1 на 1 000 000, с пик 10-14 годишна възраст [33]. ...
Бета-таласемията е едно от най-честите автозомно-рецесивни заболявания. С подобряване на хелаторното лечение и навлизането на неинвазивните методики за оценка и проследяване на желязното натрупването, качеството и продължителността на живот на пациентите с ß-таласемия значително се подобри. Черният дроб е първия таргетен орган, който се уврежда, директно и индиректно. В настоящия обзор се разглеждат най-честите чернодробни усложнения като развитие на фиброза и цироза, методи за оценка на желязното натоварване, хронични вирусни хепатити, развитие на хепатоцелуларен карцином и холелитиаза.
... These lesions usually appear as areas of increased echogenicity, although they can be hypoechoic depending on the chronicity of the infection [15]. Although fungal abscesses have been frequently reported to present as multiple small abscesses scattered in the hepatic parenchyma [36], in most of the neonates included in our study, these lesions presented as solitary lesions. In case of solitary hepatic abscess, the right lobe is more commonly affected due to its larger volume and the increased amount of blood it receives since the flow from the superior mesenteric vein goes preferentially to the right [37,38]. ...
1) Background: Although invasive fungal infections are a major cause of neonatal morbidity and mortality, data on the incidence and outcomes of localized abscesses in solid organs due to fungal infections are scarce. The aim of this study was to consolidate evidence and enhance our understanding on neonatal liver abscesses due to invasive fungal infections. (2) Methods: An electronic search of the PubMed and Scopus databases was conducted, considering studies that evaluated fungal liver abscesses in the neonatal population. Data on the epidemiology, clinical course, treatment, and outcome of these infections were integrated in our study. (3) Results: Overall, 10 studies were included presenting data on 19 cases of neonatal fungal liver abscesses. Candida spp. were the most common causative pathogens (94.7%). Premature neonates constituted the majority of cases (93%), while umbilical venous catheter placement, broad spectrum antibiotics, and prolonged parenteral nutrition administration were identified as other common predisposing factors. Diagnosis was established primarily by abdominal ultrasonography. Medical therapy with antifungal agents was the mainstay of treatment, with Amphotericin B being the most common agent (47%). Abscess drainage was required in four cases (21%). Eradication of the infection was achieved in the majority of cases (80%). (4) Conclusions: Even though fungal liver abscess is a rare entity in the neonatal population, clinicians should keep it in mind in small, premature infants who fail to respond to conventional treatment for sepsis, particularly if an indwelling catheter is in situ. A high index of suspicion is necessary in order to achieve a timely diagnosis and the initiation of the appropriate treatment.
... A potential advantage of elastographic measurement over liver biopsy is the ability to monitor liver disease progression (32). Recent studies have shown that shear wave elastography is an excellent method of assessing the degree of severity of liver fibrosis not only in adults but also in children and adolescents (23,33,34). ...
Background:
Cystic fibrosis (CF) is a multi-organ genetic disease caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene which encodes the CFTR protein. CF-associated liver disease (CFLD) is a common complication; diagnosis is based on clinical, laboratory findings and abdominal imaging. However, non-invasive diagnostic approaches are needed to early detect CFLD, its progression and severity. Recent studies demonstrate a possible role of point shear wave elastography (p-SWE) with liver stiffness measurement (LSM) as a tool for CFLD diagnosis also in children. This non-invasive technique measures liver stiffness to assess liver fibrosis and is suggested to be less operator-dependent compared to ultrasonography. Aim of our prospective observational study is to investigate the role of p-SWE with LSM for CFLD diagnosis in children and adolescents with CF and to compare this finding with aspartate aminotransferase to platelet ratio index (APRI), fibrosis index based on four factors (FIB-4) and gamma-glutamyl-transpeptidase to platelet ratio (GPR) indices.
Methods:
Fifty-nine children with CF, who had routinely undergone abdominal imaging, were consecutively enrolled. Laboratory findings and clinical data were recorded, as abdominal ultrasound and shear wave elastography at baseline. The cases were divided into two groups based on collected data and classified as CFLD and CFnoLD (without liver disease) according to Debray criteria. APRI, FIB-4 and GPR fibrosis indices were also evaluated.
Results:
Twenty-four/59 (40.7%) were defined as CFLD. LSM test is superior to the APRI (P<0.001), the FIB-4 test (P=0.001) and the GPR test for early detection of liver fibrosis. LSM had an area under receiver operating characteristic (ROC) curve =0.818 (95% CI: 0.702-0.934) compared with APRI (0.571, 95% CI: 0.421-0.722), FIB-4 (0.656, 95% CI: 0.511-0.801) and GPR (0.632, 95% CI: 0.485-0.779). At a cut-off of ≥6.2 LSM show a sensitivity of 75.0% and a specificity of 88.6%.
Conclusions:
LSM by transient p-SWE is a non-invasive, highly accessible, reliable, and reproducible test that can be used to assess early detection of liver fibrosis and its severity in children and adolescents with CF, limiting the use of liver biopsy. These preliminary observations point to the need of larger study population to confirm our data.
... Interesting studies between allergy and liver involvement have been conducted: the main role seems to be played by mast cells, a common point between the allergic cascade and that of NAFLD (14,15,16,17) ...
The internationals guidelines about food intolerances, allergy and immunity provide for rigorous steps in which ultrasonography is not provided. However there is evidence in literature about an ancillar role of ultrasonography in these conditions. In this report we analyze the main pathologies with allergic or immune pathogenesis. -------------------------------------------------------------------------------------------------------------------
NOTE: ARTURO TOZZI HAS BEEN INCLUDED BY MISTAKE AMONG THE AUTHORS OF THIS MANUSCRIPT
... Because of their atypical finding, giant pedunculated hepatic cavernous haemangiomas can be misinterpreted for GIST or peritoneal tumours, as well as other exophytic liver masses such as large simple or complex cysts, focal nodular hyperplasia, hepatocellular adenomas, hepatocellular carcinoma, and metastases [7][8][9][10][11][12][13]. In these cases, cross-sectional imaging is essential for establishing a specific diagnosis. ...
... Furthermore, the identification of the pedicle through a careful multiplanar analysis of the CT scan (with the recognition of a small and tortuous arterial vessel, which arose from the left lobe of the liver to the mass) revealed the hepatic origin of the mass. The progressive post-contrast enhancement at CT and MRI, as well as the hyperintensity on T2-weighted MRI sequences, allowed us to place it in a differential diagnosis between other potential exophytic liver lesions, such as large simple or complex cysts, focal nodular hyperplasia, hepatocellular adenomas, hepatocellular carcinoma, and metastases [7,13]. Haemangiomas are usually asymptomatic, especially in their typical form, and do not require surgical treatment except in the presence of compressive symptoms, haemorrhage, or risk factors for complications. ...
Hepatic haemangiomas are the most common benign hepatic tumour; they are usually solitary, less than 5 cm in size, and clinically silent. Giant cavernous haemangiomas are a minor subset of hepatic haemangiomas, often symptomatic due to a mass lesion, complications or compression of adjacent structures. Few of these are pedunculated-often difficult to diagnose because of their exophytic development and greater tendency towards complications through the twisting of their peduncle. We report the case of a 55-year-old woman with a giant pedunculated hepatic cavernous haemangioma causing abdominal pain, with epigastralgia mimicking a gastric stromal tumour. We discuss the diagnostic workup, focusing on the useful of computed tomography and magnetic resonance imaging findings and giving a brief report of the therapeutic management and literature review.
... O diagnóstico de tumores hepáticos pediátricos é feito com base em características clínicas, nível sérico da AFP, idade da criança e características de imagem. O ultrassom é a modalidade de imagem inicial de escolha, pois não emite radiação ionizante, não requer sedação e permite detectar, caracterizar e fornecer informação sobre a extensão das lesões hepáticas focais (1,2,6,8,10) . ...
... It can be caused by infectious spread directly from nearby structures, from the gastrointestinal tract, carried via the bloodstream from bacterial endocarditis or dental infection or from other parts of the body [1][2][3]. A liver abscess may also develop as a result of surgery or trauma to the liver [2][3][4]. ...
... As compared to developing countries where more than 66% of liver abscesses are amoebic (ALA) in origin, the predominant type (> 75%) in western countries has pyogenic (PLA) aetiology [1][2][3][4][5][6]. ...
... Over the decades, there has been significant decline in its morbidity and mortality [5][6][7]. This is largely due to the refinement of imaging techniques, improvement in microbiologic diagnosis, introduction of better antibiotics and improved supportive care [4][5][6][7]. ...
Purpose:
To evaluate and compare the efficacy of intermittent needle aspiration and continuous catheter drainage in ultrasound-guided management of liver abscesses.
Methods:
This was a prospective, randomised study conducted on 100 patients (88 males and 12 females; age range 22-74 years) with liver abscess(es) and having abscess size more than 5 cm, divided into two groups: Percutaneous needle aspiration (PNA) (n = 50) and percutaneous catheter drainage (PCD) (n = 50). Criteria of exclusion were: rupture of abscess before intervention; prior intervention; uncorrectable coagulopathy; concomitant biliary tract malignancy. In the PNA group, pus was aspirated by an 18-gauge needle using freehand technique and the number of aspirations was limited to two. Failure of abscess size to decline below 50% of the original diameter or of clinical improvement after second aspiration was considered as failure of aspiration. In the PCD group, drainage was done by 12-French catheters using Seldinger technique. Drainage was considered as failure if abscess cavity did not resolve and laparotomy was needed to evacuate the pus cavity.
Result:
The success rate in the PNA group was 88% and 92% in the PCD group; however, this difference was statistically not significant, suggesting that both are equally efficacious. The total duration of hospital stay (mean 6.8 days [PNA] vs 10.5 days [PCD]; p value: 0.011) and the average duration between intervention and discharge (5.9 days [PNA] vs 10.2 days [PCD]; p value:0.026) were significantly less in the PNA group. One major complication was seen in our study: peritonitis due to peri-catheter leak in PCD group.
Conclusion:
Both procedures are equally efficacious in the management of liver abscesses; however in view of less duration of hospital stay, patient safety and comfort, procedure simplicity, and the reduced cost, needle aspiration should be used as the first-line procedure in the treatment of liver abscess (even in abscesses more than 5 cm). Catheter drainage should be reserved for cases that do not respond to a second attempt of aspiration.
