Imaging

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

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