title: Pearls and pitfalls in hepatic ultrasonography.
abstract: Ultrasonography is often the initial imaging study in patients who present with right upper quadrant abdominal complaints. However, due to its intrinsic technical limitations, ultrasonography generally has a lower sensitivity than contrast-enhanced computed tomography or magnetic resonance imaging in detecting hepatic lesions. In this review, we describe several subtle sonographic signs that suggest the presence of an otherwise inconspicuous focal liver lesion, including disease in the pleural space or the lung parenchyma, refractive edge shadows, distorted or absent venous landmarks, abnormal Doppler patterns, and venous thrombosis. When encountered, these features should trigger careful evaluation of the adjacent areas for abnormalities and may warrant further studies with computed tomography, magnetic resonance imaging, or positron emission tomography. We also summarize common sonographic findings of diffuse liver diseases, including fatty infiltration and cirrhosis.
authors.affiliation: Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA. dsshin@stanford.edu
authors.forename: David S
authors.initials: DS
authors.lastname: Shin
authors.forename: R Brooke
authors.initials: RB
authors.lastname: Jeffrey
authors.forename: Terry S
authors.initials: TS
authors.lastname: Desser
mesh_terms: D005234:Fatty Liver / Q000000981:diagnostic imaging; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging*; D008100:Liver Abscess / Q000000981:diagnostic imaging; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging; D008107:Liver Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D011169:Portal Vein / Q000000981:diagnostic imaging; D018608:Ultrasonography, Doppler; D020246:Venous Thrombosis / Q000000981:diagnostic imaging