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Fig. 1—62-year-old woman with breast cancer treated with chemotherapy.A, Axial contrast-enhanced CT image obtained after patient had received chemotherapy treatment shows diffuse surface nodularity in liver and recanalized umbilicalvein (arrow ); these findings are suggestive of cirrhosis.B, Axial contrast-enhanced CT image obtained 6 months before A, which was before patient started chemotherapy, shows multiple hepatic metastases. Liver isotherwise normal. Setting of breast cancer metastases treated with chemotherapy indicates rapid development of diffuse changes seen in A likely representspseudocirrhosis of treated breast cancer.
B
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Fig. 2—59-year-old woman with multiple hypodense biopsy-proven hepatic metastases from invasive ductal carcinoma of breast.A, Axial contrast-enhanced CT image obtained before patient started chemotherapy.B, Axial contrast-enhanced CT image obtained 6 months after A—that is, after patient had started chemotherapy—shows diffuse hepatic nodularity, bland ascites(asterisk ), esophageal varices (arrow ), and partial regression of hepatic metastases. Findings are of pseudocirrhosis of treated breast cancer metastases; however,without prior studies and clinical history, these findings could suggest diagnosis of cirrhosis.
Fig. 3—68-year-old woman who presented for imaging after receiving two cycles of chemotherapy for hepatic metastases thought to be from primary pancreaticcarcinoma.A, Axial contrast-enhanced CT image shows liver surface is coarsely lobulated with several irregular hypodense parenchymal lesions. Appearance was consideredsuggestive of pseudocirrhosis, casting doubt on diagnosis of pancreatic cancer.B, Axial contrast-enhanced image obtained at more superior level than A shows small hypervascular lesion (arrow ) in right breast. Further workup including resection ofbreast mass confirmed diagnosis of metastatic breast cancer.
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A
Fig. 4—61-year-old man with fulminant hepaticfailure and history of chronic hepatitis B infection.A, Contrast-enhanced CT image shows nodularity(arrow ) of liver surface outlined by ascites; therefindings are suggestive of cirrhosis. Histopathologicexamination of explanted liver 5 days later showedconfluent regenerative nodules surrounded by largeareas of necrosis, but no cirrhosis. Hepatic surfacenodularity is not a reliable sign of underlying cirrhosisin fulminant hepatic failure and should not be used todiagnose cirrhosis in this setting.B, Photomicrograph of explanted hepatic surfacefrom transplant surgery performed 5 days afterA shows that irregularity of liver surface reflectscombination of confluent regenerative nodules (R)and alternating bands of necrosis (N). (H and E, ×200)
B
Fig. 5—67-year-old woman with fulminant hepatic failure that developed 6 weeks after commencement ofmethyldopa therapy for hypertension. Sagittal ultrasound image of right hepatic lobe shows nodularity (arrow )of liver surface outlined by ascites; there findings are suggestive of cirrhosis. Histopathologic examinationof explanted liver 3 days later showed confluent regenerative nodules surrounded by large areas of subacutenecrosis but no cirrhosis.
Fig. 6—64-year-old woman with metastatic lobular breast cancer. Axial contrast-enhanced CT image shows fine nodularity of hepatic surface. Liver biopsyrevealed metastatic breast cancer without cirrhosis.
Fig. 7—58-year-old woman with bilateral lobular breast cancer. Axial contrast-enhanced CT image shows widespread diffuse parenchymal and surface hepaticnodularity. Biopsy revealed metastatic disease without cirrhosis.
Fig. 8—32-year-old man with sarcoidosis. Axial contrast-enhanced CT imageshows widespread diffuse parenchymal and surface hepatic nodularity (arrow ).Appearance of liver on CT alone could be interpreted as cirrhosis, but notemultiple hypodense nodules in spleen. Retroperitoneal adenopathy (not shown)
was also present. Nodal biopsy confirmed diagnosis of sarcoidosis.
Fig. 9—44-year-old man with sarcoidosis. Axial unenhanced CT image showssplenomegaly (asterisk ) and recanalized umbilical vein (arrow ) arising fromsomewhat shrunken and irregular liver. Liver biopsy revealed sarcoidosis withoutcirrhosis. Sarcoidosis is one cause of noncirrhotic portal hypertension.
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Fig. 11—60-year-old man with portal hypertension leading to gastrointestinalbleeding, ascites, and thrombocytopenia due to biopsy-proven nodularregenerative hyperplasia in liver transplant; transplantation was performed 18years earlier for primary sclerosing cholangitis. Axial contrast-enhanced CTimage shows liver surface (arrow ) is irregular and shows relative hypertrophy ofleft hepatic lobe (asterisk ). These findings mimic those of cirrhosis.
Fig. 12—11-year-old girl with renal failure due to autosomal recessive polycystickidney disease. Coronal T2-weighted MR image shows kidneys (K) are replacedby innumerable relatively small cysts. Focal segmental biliary dilatation (arrow )in liver reflects coexistent congenital hepatic fibrosis, which can occur inassociation with autosomal recessive polycystic kidney disease and is cause ofnoncirrhotic portal hypertension. Note spleen (asterisk ) is enlarged.
A
Fig. 10—58-year-old man with history ofrenal transplantation for HIV nephropathywho presented with sepsis 1 day after righthemicolectomy for colonic volvulus.A, Sagittal ultrasound image of righthepatic lobe shows subtle echogenicnodularity of liver that could be consideredsuggestive of cirrhosis. Representativenodule (arrow ) is visible anteriorly.
B, Axial contrast-enhanced CT imageshows subtle parenchymal heterogeneityconsisting of small hypodense nodules.Representative nodule (arrow ) isvisible posteriorly. Subsequent liverbiopsy confirmed diagnosis of nodularregenerative hyperplasia.
B
Fig. 13—68-year-old man with idiopathic portal hypertension. Axial contrast-enhancedCT image shows splenomegaly (S), gastroesophageal varices (white arrow ), and ascites(black arrow ), but liver appears normal in size and contour. Liver biopsy confirmedabsence of cirrhosis; final diagnosis was idiopathic portal hypertension.