Liver mets

HISTORY: Rectal carcinoma.  Intraoperative evaluation of liver mets.

FINDINGS: Images 1-4 are intraoperative sonograms of the liver to

evaluate for metastases.  Images 1-3 demonstrate a 3 x 5 cm hypoechoic

mass seen abutting the diaphragm in the junction of the anterior and

posterior segments of the right lobe (arrows).  Note the right hepatic

vein in Images 2 and 3.  On Image 11 there is clear evidence of

refractive edge shadowing from the lesion.  On Image 4 there is a very

subtle hypoechoic lesion which was an additional satellite nodule seen

high up near the diaphragm (arrows).  Surgical resection of this lesion

confirmed an additional metastatic deposit.

DIAGNOSIS: Hepatic metastases from rectal carcinoma.

DISCUSSION: Intraoperative ultrasound has two main advantages: 1) it

improves sensitivity for detection of lesions, and 2) it provides useful

information regarding the relationship of metastases to major hepatic

vessels.  Lesions that are located in close proximity to the confluence

of the hepatic veins are often non-resectable.  In selected cases,

sonography may detect up to 16% more lesions than are not clinically

palpable at the time of surgery.