Q1: What is the significance of understanding liver sonography?
A: To evaluate normal anatomy and detect focal or diffuse pathologic changes.
Q2: How is liver pathology categorized?
A: Focal or diffuse disease.
Q3: What is an amebic hepatic abscess?
A: Abscess from Entamoeba histolytica invading liver via portal vein.
Q4: Define anastomosis.
A: Surgical connection between two structures.
Q5: What is a hepatic arteriovenous fistula?
A: Abnormal passage between an artery and a vein.
Q6: What is fatty liver (hepatic steatosis)?
A: Reversible fat deposits in hepatocytes; can be alcoholic or nonalcoholic.
Q7: What is hepatomegaly?
A: Enlargement of the liver.
Q8: Define hepatofugal flow.
A: Blood flow away from the liver.
Q9: Define hepatopetal flow.
A: Blood flow toward the liver.
Q10: What is a Riedel lobe?
A: Tongue-like extension of the right hepatic lobe.
Q11: What is a hydatid liver cyst?
A: Liver cyst caused by Echinococcus granulosus (tapeworm).
Q12: What is Budd-Chiari syndrome?
A: Occlusion of hepatic veins ± IVC, causing hepatomegaly and ascites.
Q13: What is the “starry sky” sign?
A: Increased echogenicity of portal triads in hepatitis on ultrasound.
Q14: What are the three main hepatic lobes?
A: Right, left, and caudate.
Q15: What is the quadrate lobe?
A: Medial segment of left lobe, between gallbladder fossa and round ligament.
Q16: What is Glisson’s capsule?
A: Thin fibrous covering of the liver.
Q17: What is the porta hepatis?
A: Area where portal vein, hepatic artery, and hepatic duct enter/exit liver.
Q18: What is the main portal vein formed by?
A: Superior mesenteric vein + splenic vein.
Q19: What percentage of liver blood supply comes from the portal vein?
A: ~75%; partially oxygenated.
Q20: What vessels divide the liver into segments?
A: Right, middle, and left hepatic veins; portal veins.
Q21: What is the main lobar fissure?
A: Fissure containing the middle hepatic vein; separates right and left lobes.
Q22: Which ligaments are visible on ultrasound?
A: Ligamentum venosum, falciform ligament, ligamentum teres.
Q23: What is a diaphragmatic slip?
A: Hypertrophied diaphragm muscle mimicking a pseudomass.
Q24: Normal liver echogenicity?
A: Equal/slightly greater than right kidney, slightly less than spleen/pancreas; homogeneous.
Q25: Normal liver length in adults?
A: 13–15 cm; >15.5 cm may suggest hepatomegaly.
Q26: Indirect signs of hepatomegaly?
A: Right lobe beyond kidney, rounded inferior tip, left lobe extends into LUQ.
Q27: What causes nonalcoholic fatty liver disease?
A: Obesity, diabetes, hyperlipidemia, medications, total parenteral nutrition, metabolic syndrome.
Q28: Sonographic signs of diffuse fatty liver?
A: Echogenic, poor visualization of vessels and diaphragm, sound attenuation.
Q29: What is focal fatty infiltration?
A: Localized hyperechoic area mimicking a mass, often near gallbladder/porta hepatis.
Q30: What is focal fatty sparing?
A: Areas spared from fatty infiltration, appear hypoechoic compared to surrounding liver.
Q31: Common hepatitis types?
A: A, B, C, D, E, G; A & B most common.
Q32: Transmission of hepatitis A?
A: Fecal–oral route.
Q33: Transmission of hepatitis B & C?
A: Blood, body fluids, mother-to-infant; Hep C is leading cause for liver transplant.
Q34: Sonographic features?
A: Early: normal; Later: hepatomegaly, hypoechoic, periportal cuffing (“starry sky”), thickened gallbladder wall.
Q35: Common causes of cirrhosis?
A: Alcoholism, hepatitis, Wilson disease, hemochromatosis, cholangitis.
Q36: Clinical signs of cirrhosis?
A: Fatigue, jaundice, ascites, weight loss, hepatosplenomegaly.
Q37: Sonographic signs of cirrhosis?
A: Small right lobe, enlarged left/caudate lobes, nodular surface, coarse echotexture, ascites, splenomegaly.
Q38: Portal hypertension findings?
A: Enlarged portal vein (>13 mm), hepatofugal flow, portosystemic collaterals, varices.
Q39: Common portosystemic collaterals?
A: Coronary vein, short gastric vein, splenorenal pathway, umbilical vein, anterior abdominal wall veins.
Q40: Causes?
A: HCC, cirrhosis, pancreatitis, surgery, oral contraceptives, pregnancy.
Q41: Sonographic appearance?
A: Echogenic thrombus, possible cavernous transformation (serpiginous vessels).
Q42: Clinical signs?
A: Abdominal pain, fever, leukocytosis, abnormal liver function tests.
Q43: Definition?
A: Occlusion of hepatic veins ± IVC.
Q44: Causes?
A: Congenital webs, coagulation disorders, HCC, trauma, pregnancy, OCPs.
Q45: Sonographic findings?
A: Nonvisualized/reduced hepatic veins, thrombus, enlarged caudate, absent Doppler flow, narrowed IVC.
Q46: Hepatic cysts – simple vs complex?
A: Simple: anechoic, thin wall, posterior enhancement. Complex: thick wall, debris, septations, calcifications.
Q47: Hydatid liver cyst?
A: E. granulosus parasite; “mother-daughter cysts,” “water lily” sign, possible calcifications.
Q48: Amebic hepatic abscess?
A: Entamoeba histolytica; right lobe, hypoechoic/anechoic, may contain debris, fever, RUQ pain.
Q49: Pyogenic hepatic abscess?
A: From bacteria; hypoechoic/complex cyst, debris, septations, air (dirty shadow/ring-down artifact).
Q50: Hepatic candidiasis?
A: Immunocompromised; multiple hyperechoic lesions with hypoechoic borders, target/bull’s-eye pattern.
Q51: Cavernous hemangioma?
A: Most common benign liver tumor; small hyperechoic mass <3 cm; often right lobe; may have posterior enhancement.
Q52: Focal nodular hyperplasia (FNH)?
A: Benign; isoechoic, hyperechoic, or hypoechoic; central stellate scar; estrogen sensitive.
Q53: Hepatocellular adenoma?
A: Benign; associated with oral contraceptives; hypoechoic/hyperechoic/isoechoic; risk of hemorrhage/malignant degeneration.
Q54: Hepatic lipoma?
A: Rare; hyperechoic, asymptomatic.
Q55: Hepatic hematoma?
A: Post-trauma/surgery; intrahepatic or subcapsular; echogenic initially, later cystic; may calcify.
Q56: Hepatocellular carcinoma (HCC)?
A: Primary liver cancer; hypoechoic/heterogeneous; may invade vessels; AFP elevated.
Q57: Hepatic metastasis?
A: Most common liver malignancy; hyperechoic/hypoechoic/calcified/cystic; from colon, lung, breast, pancreas, stomach, gallbladder.
Q58: Doppler – normal portal vein?
A: Hepatopetal, continuous, monophasic, 20–40 cm/s.
Q59: Hepatic veins Doppler?
A: Triphasic flow, near left atrium.
Q60: Hepatic artery Doppler?
A: Low-resistance, quick upstroke, gradual deceleration; RI 0.5–0.8.
Q61: TIPS evaluation?
A: Stent between portal vein and hepatic vein; 90–190 cm/s; check patency, reversal of flow, stenosis, clot.
Q62: Liver transplant – common indication?
A: Hepatitis C, alcoholic liver disease, cirrhosis.
Q63: Pediatric liver tumors?
A: Infantile hemangioendothelioma (benign), hepatoblastoma (malignant, associated with Beckwith-Wiedemann syndrome); may elevate AFP.
Q64: Which benign liver mass is typically isoechoic and contains a central scar?
A: Focal nodular hyperplasia (FNH).
Q65: What is the fibrous covering of the liver called?
A: Glisson capsule.
Q66: The left lobe of the liver can be separated from the right lobe by which structure?
A: Middle hepatic vein.
Q67: The TIPS shunt is placed between which structures?
A: Between a portal vein and a hepatic vein.
Q68: The right lobe of the liver is divided into segments by which vein?
A: Right hepatic vein.
Q69: The right intersegmental fissure contains which structure?
A: Right hepatic vein.
Q70: The main portal vein divides into which branches?
A: Left and right branches.
Q71: The ligamentum teres separates which segments?
A: Medial and lateral segments of the left lobe.
Q72: The main lobar fissure contains which structure?
A: Middle hepatic vein.
Q73: All of the following are located within the porta hepatis except:
A: Middle hepatic vein (porta hepatis contains portal vein, hepatic artery, common bile duct).
Q74: Right-sided heart failure often leads to enlargement of which vessels?
A: IVC and hepatic veins.
Q75: Which hepatic mass is transmitted via contaminated water in endemic areas?
A: Amebic liver abscess.
Q76: The right portal vein divides into which branches?
A: Anterior and posterior branches.
Q77: The portal vein diameter should not exceed what measurement?
A: 13 mm.
Q78: The right lobe of the liver is divided into which segments?
A: Anterior and posterior segments.
Q79: Portal veins have brighter walls than which vessels?
A: Hepatic veins.
Q80: Normal flow within the hepatic artery should demonstrate what waveform?
A: Low-resistance with quick upstroke and gradual deceleration; RI 0.5–0.8.
Q81: Budd–Chiari syndrome leads to reduced size of which vessels?
A: Hepatic veins.
Q82: A tongue-like extension of the right lobe of the liver is called?
A: Riedel lobe.
Q83: The left umbilical vein after birth becomes what?
A: Ligamentum teres.
Q84: Normal flow within the hepatic veins is described as?
A: Triphasic.
Q85: Inferior extension of the caudate lobe is called?
A: Papillary process.
Q86: Most common reason for a liver transplant?
A: Hepatitis C.
Q87: Clinical findings of fatty infiltration of the liver?
A: Elevated liver function tests.
Q88: Shortly after birth, the ductus venosus becomes what?
A: Ligamentum venosum.
Q89: Difficult-to-penetrate, diffusely echogenic liver indicates?
A: Fatty liver disease.
Q90: Most common cause of cirrhosis?
A: Alcoholism.
Q91: Clinical findings of hepatitis exclude which feature?
A: Pericholecystic fluid.
Q92: Immunocompromised patients are more prone to which hepatic abnormality?
A: Hepatic candidiasis.
Q93: All of the following are sequelae of cirrhosis except?
A: Hepatic artery contraction.
Q94: Normal flow toward the liver in portal veins is termed?
A: Hepatopetal.
Q95: Which mass is most worrisome for malignancy?
A: Hyperechoic mass with hypoechoic halo.
Q96: Most common form of primary liver cancer?
A: Hepatocellular carcinoma (HCC).
Q97: Hepatic mass associated with oral contraceptive use?
A: Hepatic adenoma.
Q98: Most common benign childhood hepatic mass?
A: Infantile hemangioendothelioma.
Q99: Clinical findings of HCC exclude?
A: Reduction in AFP.
Q100: Beckwith–Weidemann syndrome increases risk for?
A: Hepatoblastoma.
Q101: Which is associated with Echinococcus granulosus?
A: Hydatid liver cyst.
Q102: Clinical features of hydatid liver cyst?
A: Low-grade fever, RUQ tenderness, nausea, obstructive jaundice, leukocytosis.
Q103: Sonographic appearance of hydatid liver cyst?
A: Anechoic mass with debris (“hydatid sand”), “water lily” sign, mother-daughter cysts.
Q104: Clinical findings of amebic hepatic abscess?
A: Hepatomegaly, RUQ pain, malaise, dysentery (bloody diarrhea), fever, leukocytosis.
Q105: Sonographic findings of amebic hepatic abscess?
A: Round hypoechoic/anechoic mass, may contain debris or fluid-debris layering.
Q106: Clinical findings of pyogenic hepatic abscess?
A: Fever, leukocytosis, RUQ pain, hepatomegaly, abnormal liver function tests.
Q107: Sonographic findings of pyogenic hepatic abscess?
A: Complex cyst, thick wall, debris, septations, gas causing dirty shadowing or ring-down artifact.
Q108: Clinical findings of hepatic candidiasis?
A: Fever, RUQ pain, hepatomegaly, leukocytosis, abnormal liver function tests.
Q109: Sonographic findings of hepatic candidiasis?
A: Multiple small hyperechoic lesions with hypoechoic borders (“target,” “halo,” “bull’s-eye”), <1 cm, may calcify.
Q110: Clinical findings of cavernous hemangioma?
A: Usually asymptomatic, more common in women, typically right lobe.
Q111: Sonographic findings of cavernous hemangioma?
A: Hyperechoic mass <3 cm, may have posterior enhancement, color Doppler often negative.
Q112: Clinical findings of FNH?
A: Usually asymptomatic; may cause pain if mass enlarges or hemorrhages.
Q113: Sonographic findings of FNH?
A: Isoechoic/hyperechoic/hypoechoic mass with central stellate scar; hypervascularity on color Doppler.
Q114: Clinical findings of hepatic adenoma?
A: Often asymptomatic; hemorrhage may cause abdominal pain; associated with oral contraceptives.
Q115: Sonographic findings of hepatic adenoma?
A: Solid hypoechoic/isoechoic/hyperechoic mass; may have mixed echogenicity.
Q116: Clinical findings of hepatic lipoma?
A: Asymptomatic, rare.
Q117: Sonographic findings of hepatic lipoma?
A: Hyperechoic mass.
Q118: Clinical findings of hepatic hematoma?
A: Pain, decreased hematocrit, post-trauma/surgery.
Q119: Sonographic findings of hepatic hematoma?
A: Intrahepatic/subcapsular; echogenic initially, later cystic or complex; may calcify.
Q120: Sonographic evaluation of HCC?
A: Hypoechoic/heterogeneous mass, possible multiple lesions, hypoechoic halo (“target”/bull’s-eye).
Q121: Hepatic metastasis – clinical findings?
A: Weight loss, jaundice, RUQ pain, hepatomegaly, ascites, may be asymptomatic.
Q122: Hepatic metastasis – sonographic findings?
A: Hyperechoic, hypoechoic, calcified, cystic, or heterogeneous masses; may have hypoechoic rim/central echogenic area; diffuse metastasis may mimic pseudocirrhosis.
Q123: Liver Doppler – portal veins normal flow?
A: Hepatopetal, continuous, monophasic, 20–40 cm/s.
Q124: Liver Doppler – hepatic veins normal flow?
A: Triphasic.
Q125: Liver Doppler – hepatic artery normal flow?
A: Low-resistance, quick upstroke, gradual deceleration; RI 0.5–0.8.
Q126: TIPS purpose?
A: Shunt blood from portal vein to hepatic vein to reduce portal hypertension and prevent variceal bleeding.
Q127: TIPS – normal flow velocity?
A: 90–190 cm/s; check for patency and reversal of flow.
Q128: Liver transplant – common indications?
A: Hepatitis C, alcoholic liver disease, cirrhosis.
Q129: Liver transplant – sonographic evaluation?
A: Portal veins, hepatic veins, hepatic artery, IVC patent; normal waveforms; detect stenosis, thrombosis, biliary complications, fluid collections.
Q130: Pediatric liver – most common benign tumor?
A: Infantile hemangioendothelioma.
Q131: Pediatric liver – most common malignant tumor?
A: Hepatoblastoma; associated with Beckwith–Weidemann syndrome; may elevate AFP.
Q132: What is the clinical presentation of hepatoblastoma in children?
A: Hepatomegaly, palpable abdominal mass, jaundice, abdominal pain, weight loss, anorexia; AFP elevated.
Q133: Sonographic appearance of hepatoblastoma?
A: Solid, hyperechoic or heterogeneous mass; may contain calcifications or cystic spaces.
Q134: FNH central scar – how is it best detected?
A: CT or MRI; may be hyperechoic or hypoechoic on ultrasound.
Q135: FNH is estrogen sensitive. True or False?
A: True – mass may enlarge with oral contraceptive use.
Q136: Hepatic adenoma risk of hemorrhage?
A: Yes – may cause abdominal pain and risk of malignant degeneration.
Q137: Hepatic adenoma – sonographic variability?
A: Hypoechoic, hyperechoic, isoechoic, or mixed echogenicity.
Q138: Hemangioma – typical location in liver?
A: Right lobe.
Q139: Hemangioma size classification?
A: <3 cm = small; >3 cm = giant hemangioma.
Q140: Hemangioma color Doppler findings?
A: Flow often undetectable due to very slow blood movement.
Q141: Hepatic lipoma – sonographic appearance?
A: Hyperechoic, usually asymptomatic.
Q142: Hepatic hematoma – acute stage?
A: Echogenic, may be intrahepatic or subcapsular; isoechoic to liver, may be missed.
Q143: Hepatic hematoma – chronic stage?
A: Becomes cystic or complex; may calcify over time.
Q144: Hepatic hematoma can result in what vascular abnormality?
A: Arteriovenous fistula (post-trauma, biopsy, or surgery).
Q145: HCC – typical gender and associated liver condition?
A: More common in men; often with cirrhosis or chronic hepatitis.
Q146: AFP in HCC?
A: Elevated; produced by malignant hepatocytes.
Q147: Sonographic appearance of HCC?
A: Solitary or multiple masses; hypoechoic or heterogeneous; may have hypoechoic halo (“target”/bull’s-eye).
Q148: Hepatic metastasis – common primary sources?
A: Colon, lung, breast, pancreas, stomach, gallbladder.
Q149: Hepatic metastasis – sonographic appearance?
A: Hyperechoic, hypoechoic, cystic, calcified, heterogeneous; may have hypoechoic rim and central echogenic area.
Q150: Diffuse metastatic liver disease may mimic?
A: Pseudocirrhosis.
Q151: Portal vein normal flow characteristics?
A: Hepatopetal, continuous, monophasic, 20–40 cm/s.
Q152: Hepatic veins normal Doppler flow?
A: Triphasic.
Q153: Hepatic artery normal Doppler flow?
A: Low-resistance, quick upstroke, gradual deceleration; RI 0.5–0.8.
Q154: TIPS – purpose?
A: Diverts portal blood to hepatic vein to reduce portal hypertension and prevent variceal bleeding.
Q155: TIPS – normal flow velocity range?
A: 90–190 cm/s.
Q156: Signs of TIPS failure?
A: Clot within shunt, stenosis, flow reversal, flow void, abnormally high/low velocity.
Q157: Liver transplant – sonographic evaluation?
A: Check patency of portal veins, hepatic veins, hepatic artery, IVC; normal waveforms; detect stenosis, thrombosis, biliary complications, fluid collections.
Q158: Most common reason for liver transplant?
A: Hepatitis C, followed by alcoholic liver disease and cirrhosis.
Q159: Pediatric liver tumor – most common benign?
A: Infantile hemangioendothelioma.
Q160: Pediatric liver tumor – most common malignant?
A: Hepatoblastoma (often <5 years old; Beckwith–Wiedemann syndrome; AFP elevated).
Q161: Hepatoblastoma sonographic features?
A: Solid, hyperechoic or heterogeneous mass; may contain calcifications or cystic areas; may compress vasculature or biliary tree.
Q162: Clinical review – most common primary liver malignancy?
A: Hepatocellular carcinoma (HCC).
Q163: Clinical review – most common liver cancer overall?
A: Hepatic metastasis from other primary cancers.
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