X-ray diagnosis of liver

Methods of x-ray studies of the liver and biliary tract can be divided into three main groups: fluoroscopy and radiography to determine the parameters of the liver (her position, shape, size, surface, plasticity) and diagnostic pneumoperitoneum; x-ray examination of the biliary tract [cholecystography (see), Poligrafiya (see), cholangiography (see)]; x-ray examination of the blood vessels P. (splenoportography and ortografia, arteriography, venography).
On radiographs in direct projection looming top surface P., limited by a diaphragm, side and bottom contours of the right of its share. X-rays in the side projections allow you to specify the value of the right and left lobes P. and their front surface. Layered images facilitate the learning configuration and value of P., including its left part. In addition, images enable to detect the concretions or calcification and gas accumulation inside the liver or its surface.
More complete information about some morphological changes P. can be obtained using the diagnostic pneumoperitoneum (see). Changing the position of the patient and the direction of the x-ray beam, you can explore all departments P. and spleen.
X-ray methods of bile ducts are an important diagnostic tool in the liver diseases that are associated with lesions of the biliary ducts or gallbladder.
There are many different methods of angiography P. using splenoportography (see) or a straight pornografii study the morphology of the portal vein and its branch in Petrograd, the speed of the portal blood flow, the level of portal hypertension and development of collateral circulation.
In order contrasting hepatic veins from a peripheral vein carried out a catheter into the right atrium, then the inferior Vena cava and one of the hepatic veins. After the introduction of 20-25 ml of contrast produce x-rays, receiving showing part of the hepatic veins. For selective arteriography (see Angiography) through one of peripheral artery catheter is carried out in celiac or hepatic artery. Through the probe is inserted several milliliters 1 % novokaina, and then 7-10 ml 50-70% of a solution of contrast material. On the pictures the image of the hepatic artery and its branches in the liver. All methods of angiography P. allow you to set the anatomic and functional changes in venous and arterial network abnormal development, cirrhosis, intrahepatic cysts and tumors P.
In acute hepatitis is determined by a modest increase in liver and spleen. Performing the pictures are always in the same conditions, we can objectively judge the dynamics of magnitude P. and spleen. In chronic hepatitis and cirrhosis x-rays allow you to specify the form and amount P. and spleen, and discover in them calcification, especially with syphilis and tuberculosis lesions.
Important with cirrhosis study of the esophagus and stomach, where in cases of portal hypertension can be found varicose veins submucosal layer.


Fig. 34. Syphilis liver; lobed liver (pneumoperitoneum).

With focal form humongo syphilis marked increase and deformation P. or its part. Separate gum lead to surface irregularities P. and growths around it. When sclerometer syphilis liver disfigured (Fig. 34). She sealed, deformed and consists of separate segments", separated by deep hollows (lobed P.). Picture complements the enlargement of the spleen.
Purulent hepatitis causes diffuse increase Ii. In the case of the formation of large abscess appropriate Department P. increases sharply. If the abscess is formed gas, then the shots in vertical position of the patient, and if literary find the cavity in Petrograd, containing gas and liquid. The closer the abscess is located to the diaphragm, the sharper expressed secondary symptoms - limiting the mobility of the diaphragm, its high position, the irregularity of its outlines, the emergence of fluid in the pleural cavity and foci infiltration at the base of the lung.
Echinococcosis of the liver with sufficient amount of cysts is accompanied by the increase of the authority. Separate cysts can cause uneven bumps on the surface, especially clearly revealed after the introduction of gas into the abdominal cavity. In addition, if Echinococcus cyst causes narrowing and razdvigaya adjoining venous and arterial vessels. Diagnosis easier if there are lime deposits in the fibrous capsule cysts or its contents. Multicam (alveolar) Echinococcus increases and deformation P.
Malignant tumors also cause an increase in liver. Individual nodes tumor determine the tabs on the surface of the body that are better caught in the conditions of pneumoperitoneum. The increase of the right lobe P. leads to a high position in the right half of the diaphragm, and the increase of the left lobe is accompanied by deformation of the stomach left and backwards. Malignant tumors produce compression and destruction of intrahepatic vessels.
When liver damage is possible to see the loss of clarity of its outlines and the shadow of liquid (blood) in the right side of the abdomen. With fresh gunshot wounds sometimes possible to differentiate on the background shadows P. bright band of the air, filling the wound channel. Important in identifying P. foreign body. Injured P. may be complicated by the formation of abscesses and external fistula. In the latter case, the necessary fistulography (see): via the outer fistulous hole injected contrast medium that allows to judge about the direction and the ramifications of the fistula.