Hepatomegaly

Preliminary Diagnosis: Hepatomegaly

I. What imaging technique is first-line for this diagnosis

• Ultrasound with measurement of the liver in the longitudinal plane.

II. Describe the advantages and disadvantages of this technique for diagnosis of hepatomegaly.

Advantages

• Quick, inexpensive

• No ionizing radiation

Disadvantages

• Operator dependent to obtain accurate longitudinal measurements of the liver

III. What are the contraindications for the first-line imaging technique?

• No significant contraindications

IV. What alternative imaging techniques are available?

• Plain Films

• CT

• MRI

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of hepatomegaly.

Plain film (radiographs)

Advantages

• Quick, inexpensive

• Minimal radiation exposure

• Can assess for displacement of right kidney and hepatic flexure

Disadvantages

• Limited in patients with large body habitus or significant intraluminal contrast or gas-filled prominent loops of bowel overlying the right upper quadrant

• Plain films are not very specific and lack very clear anatomic detail

CT

Advantages

• Can obtain imaging very quickly

• Able to visualize the liver in multiple planes; may be able to use 3-D reconstruction

• Very specific and helpful in identifying any possible lesions/masses/nodules within the liver if intravenous contrast administered

• Although greater exposure to radiation, triple phase CT is often very informative with all liver lesions as it provides comprehensive enhancement characteristic analysis

Disadvantages

• Greater exposure to ionizing radiation than plain film radiography

• More expensive than obtaining a radiograph, ultrasound, or palpation of the liver

MRI

Advantages

• Able to better visualize the liver in multiple planes

• Very specific and helpful to identify any possible lesions/masses/nodules within the liver especially if intravenous contrast is administered

Disadvantages

• More expensive than obtaining a CT, radiograph, ultrasound, or palpation of the liver

• Requires significant patient cooperation during acquisition of the images to minimize artifact

VI. What are the contraindications for the alternative imaging techniques?

Plain films (radiographs)

• No significant contraindications

• Relative contraindication in pregnancy

CT

Pregnancy

MRI

• Absolute contraindication in patients with non-MR compatible hardware