Goubaa Mohamed MD Djerba Tunisia

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A right upper quadrant abdominal ultrasound examination is performed on a 40-year-old woman because of vague abdominal discomfort. Pay attention to the liver. Scans 4 and 5 were done 12 months after Scans 1, 2 and 3. And scans 6and 7: three years later. What has happened to the liver in the interim? Chez cette patiente de 40 ans une échographie abdominale a été réalisée pour des douleurs abdominales vagues. Regardez le foie. Les clichés 4 et 5 sont faits 1 an plus tard et les clichés après les premiers clichés 1, 2 et 3. les clichés 6et 7sont faits 3 ans plus tard.



Liver Fatty steatosis

Fatty Liver

Stéatose foie steatose hépatique

Evolution : After 12 months Evolution : 1 an apres


Evolution : three years later Evolution : 3 ans apres



Click on the image below
Cliquez sur les images en bas















































The ultrasound images of the liver show an segmental area of increased echogenicity (abnormal) in segment II, III and IV, sharply demarcated from an area of relatively decreased echogenicity (normal) in segment V, VI, VII, VIII. Additionally, Scan 1 shows clear boundaries between the areas of decreased and increased echogenicity.
Evolution :One year and three years later : The liver echogenicity appears normal. Here, the process is reversible.

Les images échographiques du foie montrent une augmentation segmentaire de l'échgènicité du parenchyme hépatique dans les segments II , III et IV bien délimité d'un secteur de l'échogènicité relativement diminué (foie normal) dans le segment V, VI, VII, VIII. En plus, le 1er cliché montre des limites nettes et rectilignes entre les secteurs de l'échogenicité diminué et accru.
Evolution : Un an et trois ans après: L'aspect du foie redevient normal. Ici, le processus est réversible




Segmental Fatty Liver Disease Stéatose segmentaire du foie


Segmental Fatty Liver Disease

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Fatty change in hepatocytes occurs in patients with diabetes mellitus, obesity, hyperalimentation, transplanted liver, alcohol abuse, and chemical toxicity. Segmental fatty liver is characterized by segmental distribution of fatty infiltration, depending on regional differences in perfusion.

Sonographic Findings :
The fatty replaced liver usually has increased echogenicity with increased attenuation. The liver is difficult to penetrate, and the vascular structures are often difficult to visualize, especially the hepatic veins. Areas of the liver may be spared from fatty infiltration. These fat spared areas appear as localized regions of decreased echogenicity within the more echogenic liver. This fat sparing most often is seen anterior to the gallbladder and the right portal vein or within the left lobe. Fatty infiltration of the liver varies in severity from mild to severe.
Because fat increases the attenuation within liver parenchyma, use of a lower frequency transducer may helpful in the imaging of patient anatomy. Care must be taken to keep in mind the loss of resolution that will accompany a lower frequency transducer. Harmonic imaging if available can be another useful tool in evaluation of the dense liver. The frame rate of the image may become degraded on certain machines with this option.

Etiology of bright liver : Differential
Fatty infiltration.
Acute alcoholic hepatitis.
Severe viral or other hepatitis.
Cardiac failure and venous congestion.
Steroid therapy particularly in conjunction with cytotoxic drugs.
Diffuse infiltration - glycogen storage disease, Gaucher's disease.
Miliary granulomata - tuberculosis.
Extensive malignant infiltration.
Infectious mononucleosis.
Portal tract fibrosis.
Fructose intolerance.
Tyrosinaemia. Radiotherapy .
wilson's disease.
Reye's syndrome.

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