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Anatomic variations and abnormalities in the diaphragm seen with US.
H C Yeh1, K P Halton, C E Gray
1Department of Radiology, Mount Sinai Medical Center, City University of New York, NY 10029-6574.
Summary
Diaphragmatic abnormalities can mimic liver masses on abdominal ultrasound (US). Recognizing features like slips, eventration, and inversion helps differentiate these from true intrahepatic lesions, improving diagnostic accuracy.
Area of Science:
- Radiology
- Medical Imaging
- Gastroenterology
Background:
- Diaphragmatic structures can present as intrahepatic masses on abdominal ultrasonography (US).
- Accurate differentiation is crucial for appropriate patient management and avoiding unnecessary interventions.
Purpose of the Study:
- To describe the ultrasonographic features of various diaphragmatic abnormalities that can simulate intrahepatic masses.
- To highlight methods for differentiating these abnormalities from true intrahepatic lesions using real-time US.
Main Methods:
- Retrospective review of 74 patients with suspected intrahepatic masses on abdominal US.
- Analysis of diaphragmatic abnormalities identified and their ultrasonographic characteristics.
- Correlation with clinical and radiological findings.
Main Results:
- Diaphragmatic slips were the most common finding (34 patients), characterized by elongated structures with multiple linear echoes when scanned longitudinally.
- Other findings included scalloping (10 patients), partial eventration (23 patients), hemidiaphragm inversion (13 patients), pleural masses (13 patients), and focal crus hypertrophy (3 patients).
- Real-time ultrasonography proved effective in distinguishing these diaphragmatic abnormalities from intrahepatic lesions.
Conclusions:
- Diaphragmatic abnormalities frequently mimic intrahepatic masses on abdominal US.
- Specific ultrasonographic features allow for differentiation, with diaphragmatic slips being the most prevalent.
- Real-time US is a valuable tool for accurate diagnosis of these conditions.