FICATUL

AD VD Sept interventricular

VS
VCS

Esofag

v. azigos

Ao toracala descendenta a. si v. pulmonare

 V. suprahepatice

VCI

v. azigos v. hemiazigos
 v.porta stg. stomac
LHS

diafragm

Lob
caudat
LHD

splina

VCI
Fisura ligamentului venos
 Ligamentul falciform Ao abd.

stomac
Ram ant.
v. porta dr.

splina

v.porta dr.
VCI v. azigos
 VB pilor Corp pancreas

D II
a. splenica

VP

RS

VCI Trunchi celiac

diafragm
 Flexura splenica a
VB pilor pancreas colonului

D II
VS

VCI VMS AMS

 Cap flexura splenica
pancreas AMS a colonului
VMS

flexura
hepatica
a colonului
v. renala stg.

D II

VCI a. renala stg

VMS AMS Anse jejunale

VCI
 mezenter Colon transvers

Colon
ascendent Colon
descendent

D III
SEGMENTATIA HEPATICA
HEPATOPATII

CIRCUMSCRISE
 Chiste biliare simple
CT cu contrast –2 imagini hipodense cu densitati lichidiene, bine de
limitate fara pereti proprii
POLICHISTOZA HEPATORENALA
Enlarged, polycystic liver. The presence of a small amount of free
fluid within the abdomen and pelvis suggests the patient may have
experienced spontaneous rupture of one or more of these intrahepatic
cysts.
 HEMANGIOMUL

CT nativ lez hipodensadine delimitata cu

densitate asemanatoare VC
Faza arteriala format.ia contrast periferic
iar in faza venoasa format. prez o incarcare
completa
 HEMANGIOM CU ARIE CENTRALA DE FIBROZA

NATIV –formatiune in LHD cu densitate asem. VCI , cu o zona centrala

de fibroza mai hipodensa decat restul leziunii
POSTCONTRAST- incarcare periferica cu densitate asem. vaselor sang.
Hemangiom gigant
CT postcontrast- formatiune heterogena sit in LHS cu cateva arii mici
de contrast periferic
Tardiv la 30 min de la injectare formatiunea se incarca partial, zonele
centrale de fibroza ramanand neincarcate
Three hemangiomas are identified: A 2 cm nodular lesion in the lateral segment of the left hepatic lobe.
Approximately 1 cm lesion in the anterior segment of the right hepatic lobe near the dome of the liver .
Approximately 1 cm lesion at the anterior aspect of the right hepatic lobe near the periphery of the liver .
These show early nodular, peripheral enhancement and progressive filling in on venous phase images.
The pancreas is mildly enlarged and heterogeneous in appearance with a dilated pancreatic duct.
A predominantly low attenuation lesion in the right hepatic lobe is noted
demonstrating intense peripheral nodular enhancement. On delayed images
this lesion becomes homogeneously minimally hyperdense compared to
the surrounding hepatic parenchyma. Multiple tiny low attenuation lesions
in the right and left hepatic lobe are noted consistent with benign hepatic
cysts.
 HIPERPLAZIE NODULARA FOCALA

A . CT FARA CONTRAST- imag. usor hipodensa cu o zona centrala mai hipodensa

B. CT CU CONTRAST- formatiunea ia contrast omogen mai putin zona centrala ce

ce constituie cicatricea stelata a leziunii
 HIPERPLAZIE NODULARA MULTIFOCALA

A. FAZA ARTERIALA – doua leziuni de hiperplazie nodulara focala

B. FAZA PORTALA – leziunile devin izodense fiind identificate doar prin cicatricea
centrala
FNH in a 10-year-old girl evaluated with multiphasic CT.
(a) Contrast-enhanced arterial-phase CT scan demonstrates
the densely enhancing, 5-cm mass with a central scar.
(b, c) Contrast-enhanced portal-phase (b) and delayed-phase
(c) CT scans show washout of contrast material from the
tumor with nonvisualization of the scar.
 ADENOM HEPATOCELULAR

Formatiune hipodensa nativ ce ia contrast central in faza

arteriala
 Adenomul hepatocelular hemoragic

Formatiune heterogena pe fondul unui ficat steatozic la o femeie

tanara ce se prezinta cu durere in hipocondrul dr. Portiunea periferica
intacta a formatiunii, ia contrast, in timp ce portiunea centrala
hemoragica nu ia contrast
ADENOM HEPATIC RECENT SANGERAT
Angiomiolipom hepatic la un pacient cu scleroza tuberoasa.
Formatiunea este situata in LHS avand densitati asemanatoare
grasimii fiind asociata cu angiomiolipom renal
LIPOM HEPATIC
CHIST HIDATIC
CHIST HIDATIC CU PERETE CALCIFICAT
CHIST HIDATIC CU VEZICULE FIICE
SI PERETE CALCIFICAT
 ABCES HEPATIC

Status post cholecystectomy

There is a large well-circumscribed mass with its epicenter in the medial segment of
the
left hepatic lobe containing an air fluid level, but mostly fluid-filled. There is patchy
attenuation throughout the left hepatic lobe. Smaller areas of low attenuation with
enhancing rims are identified adjacent to the largest collection, these are also mainly
located in the medial segment of the left hepatic lobe and the anterior segment of the
1.Abces piogen –masa hipodensa cu o
Margine inelara groasa ce ia contrast
2.Zone multiple hipodense agregate ce se
incarca cu contrast inelar periferic
3. Formatiune hipodensa cu nivel hidroaeric
ce constituie un abces cu germeni anaerobi
1.Abces amoebic- formatiune uniloculara cu perete ce ia contrast, fiind
inconjuratade o zona hipoecogena ce constituie edem perilezional.
2.Microabcese fungice post infectie cu candida albicans
ABCESE MULTIPLE CU CANDIDA
HEMATOM SUBCAPSULAR POST BIOPSIE
Active extravasation into the peritoneal cavity secondary to liver
laceration. A marked amount of fluid/blood is seen throughout the
peritoneal cavity which has increased greatly seen the previous
examination.
Transection of the medial segment of the left hepatic lobe
Transection of the medial segment of the left hepatic lobe with a large
amount of blood present in the peritoneal cavity and active
extravasation
of contrast from the injured segment of the liver.
 TUMORI MALIGNE

Carcinom hepatocelular
Masa hiperdensa in timp arterial ce devine hipodensa in timp portal
asociata cu ascita si splenomegalie
1. Hepatocarcinom bine diferentiat- imag hipodensa in timp portal,
bine delimitata cu o cicatrice centrala
2. HCC nediferentiat – formatiunea este imprecis delimitata cu
aspect
infiltrativ
1.HCC multifocal-multiple mase hipervascularizate ce ocupa aproape in
intregime ficatul . Dintre acestea doua sunt mai mari si prezinta zone de
necroza centrala
2.HCC cu aspect mozaicat ce contine zone de necroza si septe ce iau
contrast, dilatand caile biliare prin efectul de masa pe care il exercita
HCC infiltrativ difuz cu invazie a VP- incarcare neomogena cu contrast
a parenchimului hepatic asociata cu marirea in diametru a VP ce contine
imagini hipodense( trombi)
Carcinom fibrolaminar
Large low attenuation mass involving almost all of the
anterior segment of the right lobe of the liver and extending
minimally into the medial segment of the left lobe of the
liver. This shows minimal early peripheral enhancement.
Additionally, streaky hazy changes are noted in the adjacent
perihepatic fat. The portal veins are patent.The right hepatic
artery originates off the superior mesenteric artery.
There is no intrahepatic biliary ductal dilatation.
Increasing homogeneity of fibrolamellar carcinoma and
better scar visualization at delayed CT.
(a) Nonenhanced CT scan demonstrates a low-attenuation
mass with punctate calcifications within a central scar.
(b) Contrast-enhanced arterial-phase CT scan shows
initial heterogeneous enhancement of the mass.
(c) Contrast-enhanced equilibrium-phase CT scan shows
increasing homogeneity of the tumor with superior
visualization of the scar (arrow).
Fibrolamellar carcinoma in a 34-year-old patient with elevated levels of
transaminase.
A)US scan demonstrates a 15-cm echogenic intrahepatic mass with irregular
margins and a hypoechoic rim.
(b) On a contrast material–enhanced CT scan,the mass demonstrates linea
,enhancing vessels that create "compartments” within the tumor.
(c) Hepatic angiogram (arterial phase) demonstrates the large intrahepatic mass
with tortuous, irregular vessels that compartmentalize the tumor.
a, b) Contrast-enhanced CT scans (a obtained at a higher level than b)
show a 6.5-cm heterogeneous mass in the right hepatic lobe and an enlarged
lymph node adjacent and posterior to the pancreas. The lymph node
contains a central scar (arrow in b) and is compressing the inferior vena
cava. (c) Hepatic angiogram (obtained with a superior mesentery artery
injection) shows the intrahepatic vascular mass replacing the right hepatic
artery and the posterior pancreatic lymph node with an enlarged supplying
artery and neovascularity (arrowhead). The narrowing of the proximal
replaced right hepatic artery (arrow) was caused by mass effect of the
adjacent tumor and not direct arterial invasion.
Colangiocarcinom intrahepatic- imag hipodensa imprecis delimitata
in LHS asociata cu cai biliare dilatate. In imaginea tardiva obtinuta la
15 min de la injectare, formatiunea devine hiperdensa dat. retentiei
difuze a SDC in neoplasmul fibros
Metastaze de tumora carcinoida-hipervascularizate, devenind hiperdense
in faza arteriala iar in faza portala, cea mica devine izodensa iar cea mare
hipo spre izodensa
1.CT nativ –meta calcificate la un pacient cu adenocarcinom
mucinos
de colon
2. Mica metastaza ce ia contrast periferic in timp arterial
HEPATOPATII

DIFUZE
Huge, extremely fatty liver. Distended gallbladder, but no evidence of
perforation. Small ascites
Very fatty liver
Fatty liver w/focal fatty change
The liver is enlarged with diffuse fatty infiltration with areas of
increased fatty infiltration and areas of decreased fatty infiltration.
STEATOZA HEPATICA FOCALA
The liver is cirrhotic in configuration and diffusely heterogeneous in
enhancement. There is mildly patchy enhancement involving all
hepatic lobes and segments. There is patchy dilatation of the
intrahepatic biliary ducts. The spleen is enlarged.
The hepatic contour is irregular with enlargement of the left hepatic lobe consistent with a cirrhotic
morphology. A lobulated projection off the left lobe posteriorly measuring 4 x 4.5 cm is similar in appearance
to the mass described on ultrasound. This lobulation demonstrates homogeneous density similar to the liver.
An apparent tissue plane between this lobulated projection and the posterior left hepatic lobe is noted on the
inferior images. The liver itself demonstrates moderate heterogeneity with mild dilatation of the intrahepatic
ducts confined predominantly to the left hepatic lobe.The spleen is enlarged demonstrating patchy
enhancement on the initial CT images with homogeneous enhancement on delayed scan. Definitive focal
splenic lesion is not identified. Multiple perisplenic, gastrohepatic, and mild para-esophageal varices arenoted.
The liver has a cirrhotic configuration
The portal vein is thrombosed
Ascites is present. The spleen is
enlarged Multiple varices are seen at
the gastroesophageal junction, the
gastrohepatic ligament, and the splenic
hilum. Thrombus extends approximately
6 cm into the superior mesenteric vein
and partially occludes this vessel
Cirrhosis, Large Collateral Vessels
Portal vein occlusion is present with
cavernous transformation
 HEMOCROMATOZA

CT nativ- cresterea difuza a densitatii parenchimului hepatic

datorat
incarcarii cu fier
CT nativ- incarcare hepatica cu iod la un pacient tratat cu
amiodarona
- cresterea difuza a densitatii hepatice
CT nativ- zona hipodensa bine delimitata in ambii lobi hepatici la un
pacient supus unui tratament cu radioterapie
Gastric Lymphoma, Radiation Changes in Liver
The left lobe of the liver demonstrates a zone of low attenuation in the
region of the radiation port. An accessory spleen is noted.
CT nativ- adenom hepatocelular la un pacient cu boala de glicogen
tip I- formatiune neomogena in LHD iar restul parenchimului hepatic
are o densitate crescuta datorita cont. crescut de glicogen
HEPATOPATII

VASCULARE
Congenital Hepatic AVM

Dilatation of the celiac and hepatic

arteries. The hepatic artery leads to a
large enhancing mass in the left
hepatic lobe. The main, left, and right
portal veins are dilated as well.
ANEVRISM DE ARTERA HEPATICA CALCIFICAT
PSEUDOANEVRISM DE ARTERA HEPATICA
Budd Chiari
Diffusely enlarged liver with very
heterogeneous enhancement.
No visualization of the hepatic veins.
Ascites.
 SDR. BUDD CHIARI

A. CT cu contrast- incarcare neomogena a parenchimului hepatic,fara

vizualizarea venelor suprahepatice
B. 7 min de la injectare- trombi hipodensi in v. suprahepatice
 SDR. BUDD-CHIARI

A.- Incarcare neomogena mozaicata a parenchimului hepatic

- VC putin opacifiata , micsorata in diametru
- v. suprahepatice slab vizualizate
B. LC marit in dimensiuni . Ascita prezenta
TROMBOZA DE VP
CT cu contrast- trunchiul VP marit in dimensiunice nu ia contrast
Central (trombi), SDC vizualizandu-se doar periferic
 TROMBOZA DE VP

Marire in dimensiuni a ramurilor VP ce nu sunt iodofile, fiind pline

cu tombi
 Tromboza de VP cu transformare cavernoasa

A. VP marita in dimensiuni neincarcata cu SDC in zona centrala, luand

contrast doar periferic
B. 3 ani mai tarziu – multiple vene colaterale periportale dilatate
VARICE ESOFAGIENE IN CIROZA HEPATICA
 FICAT DE STAZA
CT cu contrast- VC si v. suprahepatice mult dilatate dat.
insuficientei
cardiace drepte
PATOLOGIA

VEZICII

BILIARE
 Gallbladder Carcinoma

A.Longitudinal sonogram shows a well-defined mass in the gallbladder fundus (*) that produces ill-defined
posterior acoustic shadowing. Gallstones are also present.
B.Axial unenhanced computed tomographic (CT) scan shows linear tumoral calcifications in the soft-tissue
mass within the gallbladder.
Poorly differentiated adenocarcinoma in a 67-year-old man
. (a) Longitudinal sonogram shows heterogeneous, hypoechoic, diffuse thickening of the gallbladder wall.
There is peripancreatic lymphadenopathy (*) posterior to the gallbladder
(b) Axial contrast-enhanced CT scan shows diffuse gallbladder wall thickening with a hypoattenuating mass
extending into the adjacent liver parenchyma. There is a large peripancreatic lymph node (arrow).
Moderately well-differentiated adenocarcinoma in a 55-year-old man.
(a) Transverse sonogram shows a well-defined, sessile hyperechoic mass (*) along the medial gallbladder
wall with adjacent focal wall thickening (arrow) and pericholecystic fluid.
(b) Axial contrast-enhanced CT scan shows the soft-tissue mass with focal wall thickening, extension
beyond the gallbladder wall (arrow), and pericholecystic fluid.
Intrahepatic and periportal extension of adenocarcinoma in a 53-year-old woman.
(a) Axial contrast-enhanced CT scan shows intrahepatic extension of a gallbladder carcinoma,
hepatoduodenal ligament spread, and periportal lymphadenopathy (arrows). On a more superior section
(not shown), there was bile duct dilatation.
(b) ERCP image shows a focal common bile duct stricture from periductal tumor extension.
Adenocarcinoma in a 35-year-old woman.
(a, b) Axial contrast-enhanced CT scans show peripancreatic lymphadenopathy (arrow in a) and a focal
mass in the gallbladder fundus
There is a layering density present in the gallbladder with apparent discontinuation in the gallbladder wall.
Pericholecystic fluid is present with free intraperitoneal fluid around the liver also. No air is present in the
gallbladder. Wispy infiltrative changes are present in the adjacent intraperitoneal fat consistent with
inflammation
Gangrenous Cholecystitis
There is distention of the gallbladder with wall thickening and irregular
mucosal pattern with surrounding inflammatory changes. Gallstones
are seen within the gallbladder.
Xanthogranulomatous cholecystitis in a 40-year-old woman with chronic right upper quadrant pain.
(a) Transverse sonogram of the gallbladder fossa shows marked heterogeneous thickening of the
gallbladder wall and narrowing of the gallbladder lumen (arrow).
(b) Axial contrast-enhanced CT scan shows gallbladder wall thickening and soft-tissue stranding in
the gallbladder fossa. The gallbladder lumen is very small (arrow).
Porcelin gallbladder
Thickened, calcified gallbladder wall, gallbladder contains
central
heterogeeous density material, possibly sludge or stones
Xanthogranulomatous cholecystitis in a 67-year-old woman who presented with fever, sweats, and
painless jaundice.
(a) Longitudinal US image of the right upper quadrant shows disruption of the mucosal line of the
gallbladder (arrow). The gallbladder contains echogenic material. There is pericholecystic fluid, focal
hypoattenuation in the adjacent liver, and loss of the normal plane between the gallbladder and liver.
(b) Unenhanced CT scan shows a stone impacted in the gallbladder neck, pericholecystic fluid, and
extension of the inflammatory process to the adjacent liver (black arrow) and fat (white arrow).
Xanthogranulomatous cholecystitis in a 55-year-old man who presented with right upper quadrant pain,
fever, and leukocytosis.
(a) Longitudinal US image of the gallbladder shows marked gallbladder wall thickening and prominent
hypoechoic nodules (solid arrows) in the gallbladder wall. The gallbladder mucosa is echogenic
(open arrows) and the lumen of the gallbladder compressed.
(b) Contrast-enhanced CT scan shows large hypoattenuating nodular areas in the thickening gallbladder wall
(solid arrows). There is hypoattenuation in the adjacent liver (open arrow).
Traumatism de VB
Gb laceration
Active extravasation with acute injury involving the inferior liver
margin and gallbladder
PATOLOGIA

CAILOR

BILIARE
 CHIST COLEDOCIAN
a.Dilatare de duct hepatic comun(sg alba)
si a ductului cistic(sg neagra)
Caile biliare intrahepatice periferice nu
sunt dilatate
b.dilatare de CBP
c. CT coronal- intreaga lungime a cole
ocului
 BOALA CAROLI

Arii hipodense de aspect chistic cu dispozitie dealungul cailor biliare

sugerand diagnosticul de b. Caroli ( DD cu chistele disembriogenetice)
BOALA CAROLI
 Calcul coledocian

CT cu contrast – imag hipodensa in portiunea intrapancreatica a CBP,

inconjurata de un inel periferic de contrast ( peretele CBP)
 SDR. MIRIZZI
CT nativ-calcul in reg. Infundibulara a VB
Colangiografie post ERCP – dilatari de cai biliare intrahepatice
- stenozare extrinseca a hepaticului comun
- cistic si VB neopacifiate
 Colangicarcinom
1.Dilatari de cai biliare intrahepatice pred. in
seg. lat. al LHS .Bilom in seg. medial al LHS
2. Ant. de VP, masa de t. moale sit in hepaticul
comun,lumenul rezidual fiind medial de format.
3. Colangiografie transhepatica percutana-dilat.
de cai biliare intrahepatice pred. stg.det de zona
de stenoza de pe hepaticul comun
AEROBILIE IN CADRUL COLANGITEI ORIENTALE
Biliary cystadenoma in a 55-year-old woman with abdominal pain and jaundice.
(a, b) Contrast-enhanced CT scans (a at a more cephalic level than b) show a multilocular cyst with
septations and mural calcifications (straight arrow) in the left hepatic lobe. There is biliary duct dilatation
and extension of the cyst into the left hepatic and common bile ducts (curved arrow)
Biliary cystadenoma in a 39-year-old woman with an elevated bilirubin level.
(a) Contrast-enhanced CT scan shows a small cyst in the region of the falciform ligament. There is dilatation
of the left hepatic ducts (arrow).
(b) ERCP image shows dilatation of the left hepatic and common ducts. There is a filling defect (arrow) in
the common duct from intraductal extension of the cystadenoma
Plexiform bile duct neurofibroma in a 44-year-old man with neurofibromatosis type 1 who presented
with uncontrolled hypertension.
Contrast-enhanced CT scans (a at a more cephalic level than b) show a low-attenuation mass paralleling
the intra- and extrahepatic bile ducts (solid arrow). The patient also has a pheochromocytoma of the right
adrenal gland (open arrow in b).