Gallbladder not visualized despite adequate scanning and patient repositioning; normal biliary tree — features consistent with gallbladder agenesis.
Conclusion: Gallbladder agenesis suspected — correlate with MRCP if clinically indicated.
Recommendation: Clinical correlation and/or cross-sectional imaging (MRCP) to confirm agenesis and assess biliary anatomy.
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Definition — Hepatic Simple Cyst: A benign, developmental, non-parasitic cystic lesion of the liver lined by cuboidal epithelium, usually containing clear serous fluid. Sonographically, it appears as a well-defined, anechoic lesion with thin, imperceptible walls, posterior acoustic enhancement, and without internal septations, solid components, or vascularity. Typically asymptomatic and incidentally detected, but large cysts may cause mass effect symptoms. Differentiation from hydatid cyst or cystic neoplasm is important in relevant clinical contexts.
Sonographic features — Hepatic Simple Cyst:
Case Study — 1: Hepatic Simple Cyst:
Mrs. S., 54 years old, female, presented for routine health check-up with nonspecific abdominal bloating. She had no history of jaundice, fever, weight loss, or liver disease. No history of alcohol intake or prior abdominal surgery. No relevant family history.
Clinical Examination:
Patient afebrile, no pallor or icterus. Abdomen soft, non-tender, no palpable hepatomegaly, no ascites. No stigmata of chronic liver disease. General and systemic examination unremarkable.
Laboratory Findings:
CBC: Hb 12.8 g/dL, WBC 6,400/µL, Platelets 220,000/µL.
LFT: Bilirubin 0.8 mg/dL, AST 28 U/L, ALT 32 U/L, ALP 86 U/L, Albumin 4.2 g/dL.
INR 1.0. Serum AFP within normal limits. Viral markers (HBsAg, anti-HCV) negative.
Ultrasound Examination:
Transabdominal ultrasound performed using 3.5–5 MHz convex probe.
Ultrasound Report — Hepatic Simple Cyst:
A solitary, well-circumscribed, thin-walled anechoic lesion with posterior acoustic enhancement, measuring 67 x 46 mm in the righ hepatic lobe, without septations, solid component, or vascularity. No intrahepatic biliary dilatation or additional focal hepatic lesion seen. Findings consistent with a Hepatic Simple Cyst.
Conclusion:
Benign hepatic simple cyst. No features to suggest parasitic, neoplastic, or complicated cyst.
Recommendation:
No active intervention required. Symptomatic management if bloating persists. Follow-up ultrasound only if lesion enlarges or symptoms develop.
Causes / Etiology — Hepatic Simple Cyst:
Symptoms / Clinical Features — Hepatic Simple Cyst:
Diagnostic Strategy — Hepatic Simple Cyst:
Risk Factors — Hepatic Simple Cyst:
Declaration:
I, R. K. Mouj, hereby declare that the material presented in this document titled "Hepatic Simple Cyst: Definition, Sonographic Features, Case Studies, and Risk Assessment" has been prepared and compiled by me for educational purposes only. It is intended for learning, training, and academic reference. Sources and references have been acknowledged where appropriate.
Ethics / Patient Data Statement: Any patient images, case material, or ultrasound examples included here are for academic use only, anonymised, and used with ethical consideration.
Author: ____________________
Name: R. K. Mouj [Radio-imaging Technologist]
Supervisor / Guide: Department radiologist
Department: Radiology
Institution: ____________________
Date: 16-09-2025
"Every cyst tells a story — knowing the benign from the sinister is the art of ultrasound."
Definition — Massive Hepatocellular Carcinoma (Massive HCC): A large primary malignant hepatic neoplasm occupying a substantial portion of one hepatic lobe (or the whole liver) and commonly >5 cm in diameter, often showing heterogeneous echotexture, central necrosis or cystic change, irregular margins, arterialised internal vascularity on Doppler, and may be associated with portal or hepatic vein invasion or satellite nodules. Correlate with serum AFP and cross-sectional multiphasic imaging.
Sonographic features — Massive HCC:
Case Study — 1: Single Massive HCC:
Mr. R., 61 years old, male, known chronic hepatitis B carrier with compensated cirrhosis, presented with progressive right upper quadrant pain, abdominal fullness, and early satiety for the past 6 weeks. He reported unintentional weight loss of 8 kg and intermittent low-grade fever without rigors. No history of alcohol intake in the last 10 years. No prior liver surgery or oncological treatment.
Clinical Examination:
Patient afebrile (37.9 °C), mildly icteric. Abdomen distended with a firm, irregular hepatomegaly palpable 8 cm below the right costal margin, tender to deep palpation. No clinically detectable ascites. No splenomegaly. No stigmata of advanced portal hypertension. Performance status ECOG-1.
Laboratory Findings:
CBC: Hb 11.2 g/dL, WBC 7,800/µL, Platelets 128,000/µL.
LFT: Bilirubin 2.1 mg/dL, AST 98 U/L, ALT 82 U/L, ALP 310 U/L, Albumin 3.0 g/dL.
INR 1.4. Serum AFP markedly elevated at 2,450 ng/mL.
HBsAg positive, anti-HCV negative. Renal function normal.
Ultrasound Examination:
Transabdominal ultrasound performed with a 3.5–5 MHz convex probe.
Ultrasound Report — Single Massive HCC:
Liver shows a large heterogeneous hypoechoic mass lesion in the right lobe (segments V–VIII) measuring 114x92 mm, with lobulated margins, central necrosis and prominent intralesional arterial flow on colour Doppler. Right portal vein demonstrates an intraluminal echogenic filling defect with internal vascularity, consistent with tumour thrombus. Background liver is coursed in appearance. No significant ascites.
Conclusion:
Large heterogeneous hepatic mass with arterialised vascularity and portal vein tumour thrombus — findings are most consistent with a Single Massive Hepatocellular Carcinoma (HCC).
Recommendation:
Triphasic contrast-enhanced CT or MRI liver for staging and treatment planning. Correlation with serum AFP. Multidisciplinary team (MDT) review (hepatology / oncology / surgery) advised for management decision — surgical resection vs locoregional therapy (TACE/ablation) vs systemic therapy. Assess transplant eligibility if criteria are met.
Case Study — 2: Multiple Massive HCC:
Mr. K., 69 years old, male, known case of chronic hepatitis C with established cirrhosis, presented with progressive abdominal distension, dull right upper quadrant pain, early satiety, and significant weight loss (10 kg over 2 months). He also complained of intermittent low-grade fever and generalized fatigue. No prior history of hepatic surgery or locoregional therapy. Alcohol abstinent for the last 12 years.
Clinical Examination:
Patient mildly icteric, afebrile (37.5°C). Abdomen distended with massive hepatomegaly, firm irregular liver palpable up to 12 cm below the right costal margin, crossing midline. Shifting dullness positive indicating ascites. Mild splenomegaly. No pedal edema. ECOG performance status 2.
Laboratory Findings:
CBC: Hb 10.4 g/dL, WBC 9,600/µL, Platelets 102,000/µL.
LFT: Bilirubin 3.5 mg/dL, AST 132 U/L, ALT 97 U/L, ALP 410 U/L, Albumin 2.7 g/dL.
INR 1.6. Serum AFP markedly elevated at 5,800 ng/mL.
Anti-HCV positive, HBsAg negative. Renal function preserved.
Ultrasound Examination:
Transabdominal ultrasound performed with a 3.5–5 MHz convex probe.
Liver appears cirrhotic with coarse, nodular echotexture. Multiple large heterogeneous masses are noted in both hepatic lobes, the dominant lesion in the right lobe (segments V–VIII) measures 85 x 65 mm, and another large lesion in the left lobe (segment II–III) measures 35 × 32 mm. Additional satellite nodules are seen in both lobes. Lesions are predominantly hypoechoic with central necrotic areas and irregular lobulated margins. Colour Doppler shows prominent chaotic arterial flow within the dominant masses. Right portal vein shows intraluminal echogenic filling defect with internal vascularity, consistent with tumour thrombus.
Conclusion:
Multifocal massive hepatocellular carcinoma involving both lobes of the liver, with vascular invasion (portal vein tumour thrombus) in a cirrhotic background.
Recommendation:
Triphasic contrast-enhanced CT or MRI liver for staging and treatment planning. Correlation with serum AFP. Multidisciplinary team (MDT) review advised to assess options — liver transplantation (if within criteria), locoregional therapy (TACE/TAE), systemic therapy, or palliative care depending on tumour burden, vascular invasion, and hepatic reserve.
Causes / Etiology — Massive HCC:
Symptoms / Clinical Features — Massive HCC:
Diagnostic Strategy — Massive HCC:
Risk Factors — Massive HCC:
Declaration:
I, R. K. Mouj, hereby declare that the material presented in this document titled "Massive Hepatocellular Carcinoma (HCC): Definition, Sonographic Features, Case Studies, and Risk Assessment" has been prepared and compiled by me for educational purposes only. It is intended for learning, training, and academic reference, and not for submission toward any formal degree or qualification. Sources and references used have been acknowledged where appropriate. This is my own original work. This thesis has not been submitted, either in whole or in part, for a degree at this or any other university. All sources and contributions from other authors have been clearly acknowledged and cited in the references. Where material from other authors has been used, permission has been obtained and is indicated in the text or figure captions.
Ethics / Patient Data Statement: Any patient images, clinical data, or case material included in this thesis have been used in accordance with applicable ethical guidelines and with appropriate consent or institutional approval. All identifying patient information has been removed or anonymised.
Author: ____________________
Name: R. K. Mouj [Radio-imaging Technologist]
Supervisor / Guide: Department radiologist
Department: Radiology
Institution: ____________________
Date: 15-09-2025
"Learning never stops — every question answered brings you one step closer to mastery, and every mistake is a doorway to deeper understanding."
Definition — Liver Calcification (Hepatic Calcification) : Deposition of calcium salts within the hepatic parenchyma or within ...
