Hepatomegaly sonography

Sonographical features: 1. Liver size enlarged Right lobe size > 150 mm in midclavicular line. Left lobe may extend well across midline into epigastrium.Inferior tip of right lobe seen well below the lower pole of right kidney. 2. Altered liver margins & contour Inferior margin of right lobe becomes rounded (normally sharp/pointed). Inferior margin of right lobe becomes rounded (normally sharp/pointed). 3. Parenchymal echotexture (depends on etiology): Homogeneous enlargement → e.g., early congestion, acute hepatitis. Coarse / heterogeneous echotexture → chronic liver disease, infiltration, cirrhosis. Increased echogenicity → fatty infiltration. Hypoechoic / heterogeneous → acute hepatitis, lymphoma, infiltration. 4. Vascular landmarks displaced Diaphragm pushed superiorly. Portal/hepatic veins appear elongated due to enlargement. Associated findings Splenomegaly (portal hypertension, storage disorders). Ascites (cirrhosis, right heart failure).Focal lesions (if cause is tumor, abscess, hydatid cyst).

Ultrasound report line (Findings):Liver is enlarged in size with rounded inferior margin. Parenchymal echotexture is homogeneous with normal echogenicity. No focal lesion is identified. Intrahepatic biliary radicles are not dilated. Portal vein and hepatic veins are patent with normal flow.
Conclusion: Hepatomegaly
Recommendation: Clinical correlation is required

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Symptoms:
General / Constitutional

• Fatigue
• Malaise
• Weight loss (chronic conditions)
• Fever (if infectious cause)

Abdominal Symptoms

• Right upper quadrant (RUQ) fullness or discomfort
• Sensation of abdominal distension / bloating
• Dull ache in upper abdomen (due to stretching of liver capsule)
• Pain in severe enlargement or with rapid stretching

Associated Clinical Signs (depending on cause)

• Jaundice – yellowing of skin/eyes (hepatitis, cirrhosis, obstruction)
• Nausea / vomiting / loss of appetite
• Pruritus (itching) – cholestatic disease
• Ascites (fluid in abdomen) – advanced CLD or cirrhosis
• Splenomegaly – in portal hypertension, hematologic disorders
• Peripheral edema – in cirrhosis or heart failure
• Spider angiomas, palmar erythema – chronic liver disease
• Confusion / altered mental status – hepatic encephalopathy (advanced cases)

Causes of Hepatomegaly:
1. Infective / Inflammatory

• Acute viral hepatitis (HAV, HBV, HCV, etc.)
• Chronic hepatitis
• Liver abscess (pyogenic, amoebic)
• Granulomatous infections (tuberculosis, schistosomiasis, candidiasis)

2. Metabolic / Infiltrative

• Non-alcoholic fatty liver disease (NAFLD)
• Alcoholic fatty liver
• Glycogen storage disorders
• Hemochromatosis (iron overload)
• Wilson’s disease (copper accumulation)
• Amyloidosis
• Storage disorders (Gaucher’s, Niemann–Pick)

3. Vascular / Congestive

• Congestive heart failure
• Constrictive pericarditis
• Budd–Chiari syndrome (hepatic vein outflow obstruction)
• Veno-occlusive disease
• Portal hypertension with passive congestion

4. Neoplastic

• Primary liver tumors (Hepatocellular carcinoma, Hemangioma, Adenoma)
• Metastatic deposits (commonest malignant cause)
• Lymphoma / Leukemia with hepatic infiltration

5. Miscellaneous

• Polycystic liver disease
• Cirrhosis (compensated stages with enlarged liver)
• Infiltrative diseases (sarcoidosis)

Diagnostic Strategy for Hepatomegaly:
Diagnostic Strategy for Hepatomegaly
1. History & Clinical Examination

• Onset, duration, associated symptoms (pain, fever, jaundice, weight loss)
• Risk factors: alcohol, viral hepatitis exposure, metabolic disease, heart disease, family history
• Examine for stigmata of chronic liver disease, splenomegaly, ascites, lymphadenopathy

2. Laboratory Evaluation

• Liver function tests (LFTs): AST, ALT, ALP, bilirubin, albumin, INR
• Serology: Viral hepatitis markers (HBsAg, anti-HCV, etc.)
• Metabolic tests: Iron studies (hemochromatosis), ceruloplasmin (Wilson’s), α-1 antitrypsin, lipid profile
• Autoimmune markers: ANA, SMA, AMA if autoimmune hepatitis or cholestatic disorders suspected

3. Imaging Studies

• Ultrasound (first-line): Assess size, echotexture, focal lesions, vascularity, biliary system, associated findings (splenomegaly, ascites)
• Doppler: Evaluate portal vein, hepatic vein, IVC, hepatic artery flow
• CT/MRI: Characterization of lesions, vascular anomalies, diffuse disease, staging of neoplasm
• Elastography: Assess fibrosis / cirrhosis

4. Specific Investigations (based on suspicion)

• Liver biopsy: If diagnosis remains uncertain (unexplained hepatomegaly, suspected infiltration, storage disorders)
• Echocardiography: If cardiac cause suspected (right heart failure, constrictive pericarditis)
• Endoscopy: If portal hypertension suspected (esophageal varices)

5. Synthesis & Correlation

• Integrate clinical, lab, and imaging features to classify hepatomegaly as:
• Acute: infections, congestion, acute hepatitis
• Chronic: fibrosis, cirrhosis, storage/metabolic diseases
• Focal: neoplastic, cystic, abscesses

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Note: If you select English, answer all questions in English.
यदि आप हिंदी चुनते हैं, तो सभी प्रश्न हिंदी में हल करें।

1. Which is the most common sonographic feature of hepatomegaly? 1. हेपाटोमेगाली का सबसे सामान्य सोनोग्राफिक लक्षण कौन सा है?
A. Reduced liver size / यकृत का आकार छोटा होना
B. Enlarged liver span on MCL / MCL पर यकृत का बढ़ा हुआ आकार
C. Atrophic left lobe / बायां लोब छोटा होना
D. Absent liver margins / यकृत की सीमा न दिखना

2. Normal adult liver span on ultrasound along the midclavicular line is approximately: 2. अल्ट्रासाउंड पर वयस्क में मिडक्लेविकुलर लाइन के साथ सामान्य यकृत का आकार लगभग कितना होता है?
A. 5–7 cm
B. 10–12 cm
C. 13–15 cm
D. 20–22 cm

3. Which echotexture pattern is typically seen in hepatomegaly due to fatty liver? 3. फैटी लिवर के कारण हेपाटोमेगाली में आमतौर पर कौन सा इकोटेक्सचर पैटर्न देखा जाता है?
A. Hypoechoic parenchyma
B. Increased echogenicity with posterior attenuation
C. Isoechoic parenchyma
D. Target-like nodules

4. Which condition commonly shows hepatomegaly with multiple cysts in ultrasound? 4. कौन सी स्थिति में अल्ट्रासाउंड पर कई सिस्ट के साथ हेपाटोमेगाली आमतौर पर दिखाई देती है?
A. Cirrhosis
B. Polycystic liver disease (PCLD)
C. Viral hepatitis
D. Hemangioma

5. Hepatomegaly with coarse echotexture and irregular margins suggests: 5. हेपाटोमेगाली के साथ मोटा इकोटेक्सचर और अनियमित सीमाएं किसकी ओर संकेत करती हैं?
A. Acute hepatitis
B. Cirrhosis / Chronic liver disease
C. Simple cyst
D. Normal variant

6. Which Doppler finding may be seen in hepatomegaly due to congestive hepatopathy? 6. कंजेस्टिव हेपाटोपैथी के कारण हेपाटोमेगाली में कौन सी डॉप्लर खोज देखी जा सकती है?
A. Increased arterial resistance
B. Reversal of portal vein flow
C. Dilated hepatic veins with loss of phasicity
D. Absent hepatic artery flow

7. Hepatomegaly with multiple small hypoechoic nodules (< 2 mm) is typical of: 7. कई छोटे हाइपोइकोइक नोड्यूल (< 2 मिमी) के साथ हेपाटोमेगाली किसमें विशिष्ट होती है?
A. Fatty liver
B. Hepatic tuberculosis (miliary form)
C. Metastases
D. Hemangioma

8. Hepatomegaly with homogeneous echotexture and no focal lesions is most consistent with: 8. समान इकोटेक्सचर और कोई फोकल लक्षण न होने पर हेपाटोमेगाली किसके साथ सबसे अधिक मेल खाती है?
A. Acute hepatitis
B. Fatty liver
C. Simple hepatomegaly without focal lesion
D. Cirrhosis

9. In hepatomegaly due to lymphoma, the liver usually appears: 9. लिंफोमा के कारण हेपाटोमेगाली में यकृत आमतौर पर कैसा दिखता है?
A. Hyperechoic with posterior attenuation
B. Diffusely hypoechoic with enlarged size
C. Isoechoic with calcifications
D. Multicystic with septations

10. Which of the following is NOT a sonographic feature of hepatomegaly? 10. निम्नलिखित में से कौन सा हेपाटोमेगाली का सोनोग्राफिक लक्षण नहीं है?
A. Enlarged liver span on ultrasound
B. Smooth capsule with homogeneous texture
C. Reduction of liver span below normal
D. Associated splenomegaly in portal hypertension