Imaging
Hepatomegaly
- Preliminary Diagnosis: Hepatomegaly
-
I. What imaging technique is first-line for this diagnosis
- II. Describe the advantages and disadvantages of this technique for diagnosis of hepatomegaly.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of hepatomegaly.
- VI. What are the contraindications for the alternative imaging techniques?
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
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