What is the significance of heterogeneously increased echogenicity in the liver, with a liver size of 14.4 cm, main portal vein (MPV) diameter of 1 cm, and appropriate hepatopetal flow, but poorly defined main hepatic veins (MHV)?

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Last updated: March 14, 2025 • View editorial policy

Differential Diagnosis for Heterogenously Increased Echogenicity of the Liver

  • Single Most Likely Diagnosis + Fatty Liver Disease: This condition is characterized by an increase in liver echogenicity due to fat accumulation within hepatocytes. The liver size can be normal or enlarged, and the main portal vein diameter and flow can be within normal limits, as described.
  • Other Likely Diagnoses + Chronic Hepatitis: Conditions such as chronic hepatitis B or C can lead to heterogeneous liver echogenicity due to inflammation and fibrosis. The liver size may be enlarged, and while the main portal vein diameter is within normal limits, flow can be affected in advanced disease. + Cirrhosis: Early cirrhosis might present with heterogeneous liver echogenicity, an enlarged liver, and relatively preserved portal vein flow. However, cirrhosis often leads to more significant alterations in liver morphology and hemodynamics.
  • Do Not Miss Diagnoses + Hepatic Vein Thrombosis: Although the main hepatic veins are not optimally defined, it's crucial to rule out hepatic vein thrombosis, especially in patients with risk factors such as coagulopathy or malignancy. This condition can lead to Budd-Chiari syndrome, which is life-threatening. + Hepatocellular Carcinoma (HCC): In patients with risk factors such as cirrhosis or chronic hepatitis, HCC should be considered, especially if there are focal lesions within the liver. HCC can cause heterogeneous liver echogenicity and can be life-threatening if not diagnosed early.
  • Rare Diagnoses + Amyloidosis: Hepatic involvement in amyloidosis can lead to increased echogenicity due to the deposition of amyloid proteins in the liver. This condition is rare and usually presents with systemic symptoms. + Sarcoidosis: Hepatic sarcoidosis can cause granulomatous inflammation, leading to increased liver echogenicity. It is part of a systemic disease and might be considered in patients with known sarcoidosis or other systemic symptoms.

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