Liver Cirrhosis and its Complications: Key Ultrasound Findings
- Dr. Segnini
- Jan 13
- 3 min read
Ultrasound as a Liver Monitoring Tool:
Liver cirrhosis is the final stage of progressive liver fibrosis, resulting in distortion of the liver's normal architecture and the formation of regenerative nodules. Abdominal ultrasound is a fundamental tool in diagnosis, staging , and, above all, in the early detection of complications that determine the patient's prognosis, such as portal hypertension and hepatocellular carcinoma (HCC).
The Integral Role of Ultrasound in the Management of Cirrhosis:
Suggestive Diagnosis: Identifies characteristic morphological changes, although biopsy remains the gold standard for confirming fibrosis.
Detection of Complications: It is the first-line method for monitoring portal hypertension and semi-annual screening for HCC.
Guide to Procedures: Essential for performing paracentesis, liver biopsies, or the placement of portosystemic shunts .
Non-Invasive Monitoring: Allows monitoring of disease progression and response to treatments.
Ultrasound Findings in Cirrhosis and its Complications:
A) Direct Parenchymal Changes (Mode B):
Nodular and Heterogeneous Texture: The parenchyma loses its fine, homogeneous echogenicity . A "granular" or "nodular" pattern is observed, especially on the surface.
Nodular and Irregular Surface: Instead of a smooth and well-defined border, the liver contour appears bosselled or micronodular .
Right Lobar Atrophy with Caudate Lobe Hypertrophy: Characteristic sign. The diameter of the caudate lobe approaches or exceeds that of the right lobe (caudate/right index >0.65).
Increased Parenchymal Echogenicity : The liver appears more "white" ( hyperechoic ) compared to the renal cortex, due to fibrosis and frequent concomitant fat deposition.
B) Complications of Portal Hypertension (Evaluated with Color and Pulsed Doppler ):
Splenomegaly: Increased size of the spleen (>13 cm in its longitudinal axis), indicative of splenic congestion.
Umbilical vein recanalization: An anechoic tubular structure extending from the left portal vein to the umbilicus. It is a specific sign of severe portal hypertension.
Dilation of the Portal Vein and Portosystemic Collaterals : The portal vein may measure >13 mm. Collaterals such as esophageal varices ( visible at the esophageal hiatus) or dilated left gastric veins are sought.
Ascites: Free fluid ( anechoic areas ) in dependent spaces such as the hepatorenal (Morrison's space), flanks, and pelvis.
Changes in Portal Flow ( Doppler ): Normal flow is hepatopectal (towards the liver). In advanced hypertension, it can become slow, bidirectional, or even hepatofugal (reversed). The mean portal flow velocity decreases (<15 cm/s is suggestive).
Hepatocellular Carcinoma (HCC):
Mandatory semi-annual screening protocol in cirrhotic patients.
Ultrasound findings of HCC: Solid nodule, usually hypoechoic (darker) compared to the surrounding cirrhotic parenchyma. May present with an echogenic halo and typical arterial vascularization on Doppler ( wash -in pattern on contrast studies, if contrast-enhanced ultrasound is used).
Limitations and Considerations:
Ultrasound may be normal in early stages of cirrhosis (compensated cirrhosis).
Interpretation is more difficult in very heterogeneous and obese livers.
It is an operator-dependent technique. Clinical and laboratory correlation is crucial.
Conclusion:
Ultrasound is a cornerstone of the comprehensive management of patients with cirrhosis. It not only provides a presumptive diagnosis but also acts as an early warning system for serious complications. Its ability to assess liver morphology, detect signs of portal hypertension, and perform repeated, non-invasive screening for hepatocellular carcinoma (HCC) makes it an irreplaceable tool in clinical hepatology.
Ultrasound findings in liver cirrhosis
Dr. Jose Segnini, Radiologist / Diagnostic Medical Sonographer
MD Radiologist (Venezuela – Chile)
Board Certified Diagnostic Medical Sonographer (ARDMS, USA)
Mobile Ultrasound & Medical Supplies – Orlando, Florida
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