Sonographic criteria for diagnosing Hepatomegaly.

Sonographic criteria for diagnosing Hepatomegaly.

• Posted by Dr MM Nurus shafi on March 9, 2010 at 8:04am in General & Abdominal Ultrasound Community
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Can this  so simple question generate a debate ?

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Permalink Reply by Bashir H Samma;MD,PGD&C,SrMAIUM on March 11, 2010 at 1:00pm

I usually do not rely much on the lowest "scannable margin" of the hepatic right lobe below the costal margin along the mid-clavicular line, but on the total mass of the liver....in x, y and z dimensions.

An adult liver should be about 1000g to 1800g (same figures in cc, assuming the density of living tissue to be 1g/cc, that the same as that of water.

Individuals with emphysema from smoking or any other cause may have PSEUDO-HEPATOMEGALY as the liver is "pushed" down by the lungs. One may then have an impression of a "sonographically palpable" hepatic margin.

All in all, a good clinical history usually add up to the observations.

Hope this helps

Permalink Reply by dr rizwan ali on March 11, 2010 at 2:59pm

DEAR SIR;
Its nice of you to share your extended experience but for beginners and learners it could be better if you explain us different protocols and guidelines before you add you experience,for instance what are para-meterss by AIUM,BMUS,ASUM etc and then personal experience,please take it positive and guide us.

Bashir H Samma;MD,PGD&C,SrMAIUM said:

I usually do not rely much on the lowest "scannable margin" of the hepatic right lobe below the costal margin along the mid-clavicular line, but on the total mass of the liver....in x, y and z dimensions.

An adult liver should be about 1000g to 1800g (same figures in cc, assuming the density of living tissue to be 1g/cc, that the same as that of water.

Individuals with emphysema from smoking or any other cause may have PSEUDO-HEPATOMEGALY as the liver is "pushed" down by the lungs. One may then have an impression of a "sonographically palpable" hepatic margin.

All in all, a good clinical history usually add up to the observations.

Hope this helps

Permalink Reply by Dr MM Nurus shafi on March 13, 2010 at 1:21am

Thanks Dr Bashir & Dr Rizwan for nice replies. I was having some experience in Singapore Gen Hosp. A asked a Sonographer the same question. That chinese Miss answered, when the inferior & rt lateral margin of the liver are convex, bulging outward, the Ap diameter is thick & when the caudate lobe is prominnt , we consider hepatomegaly.

Permalink Reply by Syed Amir Gilani on March 14, 2010 at 4:27pm

Good topic need friday to send more details or rather fridays (as in sudan friday is off and I am now a days spending two weeks in sudan and two in Pakistan where sunday is off).There are some methods which need debates--volume mentioned by dr bashir samma is good but we need something easier,a diameter is always easier to measure as compare to voulme as third measurment of trans-axial and in some structures coronal is difficult to get --spleen and liver are exmaples.
What i teach my students now i days are 1) voulme of liver 2) 7 measurements 3) one ratio-----as routine in 2 minutes in almost all patients coming with request of liver scanning
1) CAUDO-CRANIAL MEASUREMENT OF FULL LIVER--Usually at mid-clavicular line but practically ant-axillary line is better.Rt.Kidney is recomended in the view---rule of thum is the liver from tip of left lobe to diaphragm shall be in the view (firled of view) whereas we have normals for this measurement ranging from 14cm to 16.5 cm although it depends on body height and habbitus too.
Some people prefer to use (as in jefferson-USA) i saw a line is drawn straight from the lowest most corner of left lobe and another line is drawn from middle of dome --which touches the first line drawn.They say 14.5 cm is normal.
2) AP Diameter of right lobe--midclavicular line-- nromal 13.5 to 15.5cm again above mentioned factors effect.
3) CAUDO-CRANIAL Diameter of right lobe--- subcostal approach works best,oblique can work--13-14cm is taken normal. 4) LEFT LOBE-AP; Epigastrium transverse probe AP measurement is 10-12 cm whereas
5) LEFT LOBE-CC is 8-10.5cm.
6) CAUDATE LOBE-AP= 2.5 cm is upper limit
7) CAUDATE LOBE; CC= 6-7cm is normal.
RATIO---RIGHT LOBE AND CAUDATE LOBE RATIO-Caudo cranial measurement
Caudate lobe must not be more than 67% of right lobe in any case.
There ar emany variations and standards in these------------- i have some referneces,guidelines and some studies of my own students.
I look forward to hear more.

Permalink Reply by Syed Amir Gilani on March 14, 2010 at 4:29pm

dear dr bashir
the third dimension measurement is a problem even for experts in some patients.
do you have any other idea.As you have worked in an area where liver diseases I guess are more.

Bashir H Samma;MD,PGD&C,SrMAIUM said:

I usually do not rely much on the lowest "scannable margin" of the hepatic right lobe below the costal margin along the mid-clavicular line, but on the total mass of the liver....in x, y and z dimensions.

An adult liver should be about 1000g to 1800g (same figures in cc, assuming the density of living tissue to be 1g/cc, that the same as that of water.

Individuals with emphysema from smoking or any other cause may have PSEUDO-HEPATOMEGALY as the liver is "pushed" down by the lungs. One may then have an impression of a "sonographically palpable" hepatic margin.

All in all, a good clinical history usually add up to the observations.

Hope this helps

Permalink Reply by DR,Mujibur Rahman on March 15, 2010 at 2:53am

Thank u Prof. Gillani for ur valuable comment on Hepatomegaly, but what will be the measurment for hepatomegaly in case of children 6-12 yrs.

Syed Amir Gilani said:

Good topic need friday to send more details or rather fridays (as in sudan friday is off and I am now a days spending two weeks in sudan and two in Pakistan where sunday is off).There are some methods which need debates--volume mentioned by dr bashir samma is good but we need something easier,a diameter is always easier to measure as compare to voulme as third measurment of trans-axial and in some structures coronal is difficult to get --spleen and liver are exmaples.
What i teach my students now i days are 1) voulme of liver 2) 7 measurements 3) one ratio-----as routine in 2 minutes in almost all patients coming with request of liver scanning
1) CAUDO-CRANIAL MEASUREMENT OF FULL LIVER--Usually at mid-clavicular line but practically ant-axillary line is better.Rt.Kidney is recomended in the view---rule of thum is the liver from tip of left lobe to diaphragm shall be in the view (firled of view) whereas we have normals for this measurement ranging from 14cm to 16.5 cm although it depends on body height and habbitus too.
Some people prefer to use (as in jefferson-USA) i saw a line is drawn straight from the lowest most corner of left lobe and another line is drawn from middle of dome --which touches the first line drawn.They say 14.5 cm is normal.
2) AP Diameter of right lobe--midclavicular line-- nromal 13.5 to 15.5cm again above mentioned factors effect.
3) CAUDO-CRANIAL Diameter of right lobe--- subcostal approach works best,oblique can work--13-14cm is taken normal. 4) LEFT LOBE-AP; Epigastrium transverse probe AP measurement is 10-12 cm whereas
5) LEFT LOBE-CC is 8-10.5cm.
6) CAUDATE LOBE-AP= 2.5 cm is upper limit
7) CAUDATE LOBE; CC= 6-7cm is normal.
RATIO---RIGHT LOBE AND CAUDATE LOBE RATIO-Caudo cranial measurement
Caudate lobe must not be more than 67% of right lobe in any case.
There ar emany variations and standards in these------------- i have some referneces,guidelines and some studies of my own students.
I look forward to hear more.

Permalink Reply by DR,Mujibur Rahman on March 15, 2010 at 2:59am

Thank u Dr. N Safi for raising this question. I think in practice life this is not a easy question, rather it is very difficult to comment regarding the hepatomegaly in case of children that what is the measurment for child.

Permalink Reply by dr rizwan ali on March 17, 2010 at 4:32am

dear seniors
I disagree with idea of volume ,as practically it is almost impossible by ultrasound.
the measurements prof gilani has given are different from we find in books thirdly there was a question about size in children??we need details please.

Permalink Reply by Syed Amir Gilani on March 18, 2010 at 11:44am

yes their are different crietrias the one i mentioned is for the south east asia and africa.It is very accurate for these regions.I have a chart for children shall send latter today.
Volume assessment is difficult but not wrong.

Permalink Reply by j.k james on March 19, 2010 at 12:30pm

I agree with prof.Gilani,pat height is important,volume yes a little bit difficult to measure I have never measured it in my 30 years of experience.Caudate lobe rt lobe ratio is vital.Areas with tropical diseases must have larger livers,there r some problems for instance a patient having liver 13cm never had a scan,now is under acute attack of hepatitis the size can go upto 13.5 or 14 max.If our upper limit is 15 or say 14.5cm---how can we lable it as enlarged liver.Specially if he had no liver scan before.yes,centrilobular pattern ,peri-portal fibrosis all accepted--we are discussing size of liver.How can we know that liver is larger than this individual's normal size---any body can help me.

Permalink Reply by Syed Amir Gilani on March 20, 2010 at 7:35am

dear friends here are attached details of adult and paediatric sizes of liver.

Attachments:

• liver measurements.doc, 41 KB

Permalink Reply by Syed Amir Gilani on March 20, 2010 at 7:42am

BETTER TO SEE ATTACHMENT.
ADULT LIVER
Diameter International Mean +/-SD(cm) South East Asia & Africa (East & central)-- Mean +/-SD(cm)
Gilani.et.al



DR,Mujibur Rahman said:

Thank u Dr. N Safi for raising this question. I think in practice life this is not a easy question, rather it is very difficult to comment regarding the hepatomegaly in case of children that what is the measurment for child.

Attachments:

 

Replies to This Discussion

Permalink Reply by Syed Amir Gilani on March 24, 2010 at 7:13am

Have anyone tried the measurements I sent to the forum,kindly update when ever you find aany ddifference.

Permalink Reply by Bashir H Samma;MD,PGD&C,SrMAIUM on March 29, 2010 at 3:46pm

It a great criteria for hepatomegaly, Prof Gilani. As for the xyz dimensions, I tries even to use a cardiac probe to beam through the ribs in standing pose. I shall try your criteria and compare.

regards,