Question about ultrasound...

[happymom2v]

Hi Dr.
In addition to a CT, there was an ultrasound preformed because of elevated liver enzymes. Ultrasound showed
"Liver: there is increased parenchymal echogenicity. There are no hepatic lesions".
What does " increased parenchymal echogenicity" mean?
Please let me know. Am always worried something will happen to new liver.
Thank you in advance.

[happymom2v]

Thank you sooo much for answering all my questions. I appreciate it :-)

[Thomas D Schiano, MD]

go up and down--they can be mildly increased at times and spontaneously return to normal

[happymom2v]

What do you mean by "Liver tests can ebb and flow sometimes"? What does ebb refer to?

[Thomas D Schiano, MD]

i am not sure actually.  Agaain, i am not concerned about the imaging results.  Liver tests can ebb and flow sometimes and should be followed over time

[happymom2v]

The liver enzymes ( Alt, Ast, Alk Phos and GGT) were actually slightly elevated the day of the CT scan. That's the reason the ultrasound was ordered for the next day. Fortunately, within a few days, the liver enzymes all  returned back within normal limits. Is there a reason why that could happen? Is that possibly the reason that the u/s showed "increased parenchymal echogenicity"?
Thank you for helping me.

[Thomas D Schiano, MD]

allograft livers can also have a little nonspecific inflammation or scarring.  This should not be of concern.  the parenchymal ehcogenicity and shunting are presumably related and i believe are normal findings post-transplantation, especially if the liver tests are normal

[happymom2v]

What causes scarring or inflammation to a newly transplanted (1 year ago) liver?  An ultrasound done 6 MONTHS ago did not indicate the " increased parenchymal echogenicity"... Is this a reason for concern? Also is "parenchymal echogenicity"  and a "vascular shunt" mean the same thing or are these two different findings?
Thank you for helping me.

[Thomas D Schiano, MD]

means there is a little bit of scarring or inflammation--another typical finding

[happymom2v]

Thank you very much. I appreciate you answering my questions.
What does " increased parenchymal echogenicity" mean?

[Thomas D Schiano, MD]

the liver explant histology is extremely favorable--there is a very low risk for recurrence.  I dont think its necessary to get an MRI.  The vascular shunts arre typically seen after a transplant and are inconsequential and nothing to worry about

[happymom2v]

Hi Dr. Thank you for your response

A CT was preformed in addition to the ultrasound. This is what was noted regarding the portal vein thrombosis."Again noted is occlusive thrombosis of the native portal vein, SMV and splenic vein at the confluence."

In regards to the explant liver, according to the pathology report, "the specimen reveals a 1.2cm partially necrotic subcapsular nodule in right lobe. The necrotic nodule demonstrates residual moderately differentitated hepatocellular carcinoma. Tumor confined to liver. Hilar margin is uninvolved by carcinoma. Primary tumor. pT1: solitary tumor without vascular invasion"

Should I worry about HCC? Should I push for an MRI or is the CT sufficient enough for HCC monitoring and as well as monitoring the portal vein thrombosis?

On the ultrasound, it does say regarding the Liver: there is increased parenchymal echogenicity. There are no hepatic lesions". What does " increased parenchymal echogenicity" mean? Is this another word for "vascular shunts"? Why does this happen post liver transplant and is this typical? Does it ever resolve itself or is this permeant?

Thanks in advance.

[Thomas D Schiano, MD]

CT scans and MRIs are typically better tyhan ultrasounds which are more operator-dependent.  I think that you should have one to confirm the portal vein thrombosis.  none of the findings that you describe are suspicious for recurrent HCC.  Most programs have screening programs post-transplant to assess for recurrence.  the most important predictor for recurrence is the histology of the liver explant.  the findings that you describe can typicvally be seen post transplant.

[happymom2v]

Hi Dr.
I am one year POST transplant.
In addition to a CT, there was an ultrasound preformed because of elevated liver enzymes. Ultrasound showed
"Liver: there is increased parenchymal echogenicity. There are no hepatic lesions".
1. What does " increased parenchymal echogenicity" mean?
2. Ultrasound from 6 months ago indicates "The liver is normal in size and echogenicity."... How could this change in 6 months?
3. Recent CT shows "multifocal predominantly peripheral areas of arterial phase hyperenhancement that equilibrate with the liver parenchyma in the portal and delayed venous phases. None of these observations demonstrate washout or capsule/pseudocapsule.
4. Are the ultrasound and CT referring to the same thing?
5. There is an occlusive thrombosis of proximal main portal vein at the portosplenic confluence. Could this be causing these abnormalities of what is being seen in the ultrasound and CT scan?
6. Is this something I should worry about or will it lead to HCC? Prior to transplant the AFP was normal however the worry of HCC returning is an enormous fear.
7. Should I push for an MRI with contrast versus a CT with contrast?

Please let me know. Am always worried something will happen to new liver.
Thank you in advance.

[happymom2v]

Also...I am Post liver transplant.