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Revista Española de Cardiología is an international scientific journal dedicated to the publishing of research write-ups on cardiovascular medicine. The journal, published because 1947, is the official publication the the Spanish culture of Cardiology and founder the the REC Publications newspaper family. Write-ups are released in both English and also Spanish in its electronic edition.


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Hígado y enfermedad cardiovascular: lo que el cardiólogo debería conocer de los hallazgos ecográficos

Given the anatomical proximity that the liver and also gallbladder come the heart, cardiologists should have the ability to identify details common conditions affecting these organs that may have far-ranging clinical ramifications for patience management. Here, us present usual findings with regard to liver echogenicity, size and also edges, and also focal lesion study.

A regular liver is minimally hyperechogenic or isoechogenic compared with the regular renal cortex1 (Figure 1A and B). The most common reason of hyperechogenic liver (increased liver echogenicity contrasted with the renal cortex) in routine practice is steatosis, otherwise recognized as “fatty liver”. This deserve to be one of two people diffuse or focal.


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Figure 1.

A: typical liver echogenicity. B: Increased liver echogenicity (steatosis), v respect come the renal parenchyma. C: Intact hypoechoic area of geography morphology adjacent to the gallbladder within steatosis (asterisk). D: Area of focal length sparing of the liver anterior to the portal bifurcation (arrow). E: Hyperechogenic area of focal length steatosis anterior come the portal bifurcation (arrow). F: Areas the patchy steatosis. PB, portal bifurcation; GB, gallbladder.


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Areas of intact parenchyma are typically found in ~ diffuse steatosis. These areas are hypoechoic, as they exchange mail to “islets” of normal liver parenchyma that comparison with the pathological liver (with boosted echogenicity due to the fat infiltration).

Focal locations of fat infiltration can also be found, ie, areas of enhanced echogenicity versus the background of common liver parenchyma.1,2

Both the undamaged parenchymal locations within diffusive steatosis and also the locations of focal distance steatosis in common liver have geographical borders, room not associated with fixed effect, readjust over time (sometimes quickly), and are usually situated in subcapsular or perivesical areas, surrounding to the portal bifurcation and also the falciform ligament. They can, however, be found in any kind of location. Occasionally, these locations may resemble nodules/solid masses2 (Figure 1C-F).

Normal liver echogenicity is homogeneous, through fine echoes.1 one of the main reasons of heterogeneous echogenicity of the liver is chronic liver disease/cirrhosis (Figure 1 the the supplementary material). Other common conditions resulting in heterogeneous echogenicity room patchy steatosis and also diffuse tumor infiltration.2

In liver congestion prompted by right-sided heart failure, such together tricuspid regurgitation, a diffuse decrease in liver echogenicity have the right to be observed.

Other usual findings that chronic liver disease/cirrhosis encompass volume redistribution, with rise in the caudate lobe, the left lobe, or both, v respect to the appropriate lobe, and also liver surface ar irregularity.1 these findings can happen in patients through Fontan circulation. The irregularity/nodularity the the liver edge is much more obvious if there are ascites, which are often existing in decompensated liver disease.

Hepatomegaly and also dilation the the inferior vena cava and also suprahepatic veins are common findings in liver congestion, such as in tricuspid regurgitation and also Ebstein anomaly.

Ultrasound is useful for distinguishing between cystic and also solid lesions, whose administration tends to differ significantly.

On ultrasound, lesions are characterized as a basic cyst as soon as it is anechogenic, with thin, smooth walls and also posterior acoustic enhancement. A cystic lesion is complex if it does not fulfil all these characteristics, ie, if it has a thick or irregular wall, v mural nodules, septations, echogenic content, or calcifications. Hydatid cysts and abscesses are typical examples of complicated cystic lesions (Figure 2E-H).


A solid nodule have the right to be hyperechogenic, isoechogenic or hypoechogenic through respect come the nearby parenchyma, it can be homogeneous or heterogeneous, and flow may be detected in the Doppler study, return a an adverse result go not dominance out a heavy lesion. If a solid nodule is detected, it have to be contrasted with any kind of previous researches that may be easily accessible to evaluate even if it is it is a new nodule, is stable, or has actually grown, and also it must be correlated with the patient's medical background (eg, background of tumors, hepatitis B or C virus infection, alcoholic cirrhosis) because that a decision to it is in made top top the performance of any additional imaging tests.

The benign nodules most frequently observed in practice include hemangioma, which has a usual appearance that a hyperechogenic nodule with well-defined borders.

The 2 many common varieties of malignant hepatic lesions space metastasis and hepatocellular carcinoma.

There are usually various metastases and their ultrasound figure is highly variable (hyperechogenic, isoechogenic or hypoechogenic compared with the nearby parenchyma, and also they deserve to be homogeneous or heterogeneous, either v or without a halo, and also may also be cystic or have calcifications3,4) (Figure 2A-D).

In many cases, hepatocellular carcinoma is found in a liver through chronic liver disease/cirrhosis. The can current as a heavy nodule (or various in the case of multicentric hepatocellular carcinoma) and can be hyperechogenic, isoechogenic or hypoechogenic, occasionally with a halo.3 This would because of this be the first diagnostic possibility upon exploration of a hard nodule in a liver with indicators of chronic liver disease/cirrhosis.

With regard come the gallbladder, its typical content is anechogenic. Any type of echogenic content is pathological and may correspond to stone formation (hyperechogenic images, usually through posterior acoustic shadowing), biliary sludge, blood, pus, or debris. The echogenic content is identified by its activity with transforms in patient place (unless it is very closely adhered to the wall), which differentiates it from the focal thickening dependency on the wall (polyps or masses) (Figure 2 of the supplementary material).

The typical gallbladder wall surface is smooth, with a thickness the ≤ 3 mm.1 focal distance thickening (usually polyps, either single or multiple) and also diffuse thickening can be checked out in the wall.

Diffuse wall thickening may be due to gallbladder condition (mainly acute cholecystitis) or extracholecystic causes. The is generally identified as a hypoechogenic area in between 2 echogenic present or may have a grooved or layered appearance.

Typical findings in acute cholecystitis incorporate bladder distention, diffuse wall thickening, cholelithiasis or biliary sludge, and positive Murphy sign on ultrasound. Acalculous cholecystitis is much much less common and occurs in patients v a long-term, crucial condition (eg, patients admitted come the intensive treatment unit). Diffusive thickening that the gallbladder wall, except that resulted in by inflammation in the context of acute cholecystitis, may be because of extracholecystic reasons such together liver dysfunction (associated with alcoholism, hypoalbuminemia, ascites and/or hepatitis), congestive love failure, renal disease, pancreatitis, mononucleosis symptoms, AIDS, and sepsis5 (Figure 3 the the supplementary material).

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By utilizing the an easy concepts presented on the most typical conditions the the liver and gallbladder, cardiologists can overview the suitable management of patient undergoing echocardiograms.