Ultrasound images of focal liver lesions pediatric

Liver metastases may occur from most paediatric
malignancies, particularly neuroblastoma, rhabdomyosarcoma and Wilms’ tumour (p. 229).
Leukaemia and lymphoma may also cause focal defects in the liver. Liver involvement may be manifested by hepatomegaly with normal liver texture, a non-specific sign, or by diffuse coarsened liver texture with or without hepatomegaly.

Ultrasound images of Haemangioendothelioma Vascular tumours account for most benign liver tumours in childhood, with haemangioendotheliomas being seen more frequently than cavernous haemangiomas. Although haemangioendothelioma may be asymptomatic, infants generally present before the age of 6 months with an abdominal mass, respiratory distress, anaemia and cardiac failure, caused by the shunting of blood from the
aorta through the tumour. Large tumours may bleed spontaneously, resulting in haemoperitoneum.
They may present with jaundice and increased transaminase levels and 50% of children
also have cutaneous haemangioma. These tumours are generally multiple, of varying
echogenicity and may have a complex echotexture due to thrombus, calcifications and internal septations (Fig. ultrasound images below).

Ultrasound images of Multiple hypoechoic haemangiomata. Hyperdynamic circulation was noted in the portal vein and hepatic artery on Doppler.
These lesions spontaneously regressed, leaving only a solitary haemangioma at the time of going to press.

The vascular nature of these lesions is demonstrated by a large coeliac axis and
marked decrease in the size of the aorta below the origin of the coeliac axis. The main differential diagnosis of multiple haemangioendothelioma is from metastatic liver disease, particularly from disseminated neuroblastoma.
Although most asymptomatic paediatric haemangioendotheliomas regress spontaneously, those complicated by cardiac failure require active treatment.
Steroids may be administered and serial ultrasound scans may be used to monitor the gradual resolution of the lesion. Angiographic embolization or surgical ligation of the major feeding vessels of the hepatic artery may be necessary in severe cases that fail to respond to steroid therapy.

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