Presentation
Alcoholic for more than ten years with right upper quadrant pain. Previous history of cholecystectomy.
Patient Data
The liver shows a coarse echotexture and a modest diffusely increased echogenicity. It has a span of 14.3 cm. There was no mass seen. The contour of the capsule was relatively smooth.
A cluster of varices near the porta hepatis suggests that the portal vein may have undergone a cavernous transformation. The flow and caliber of the hepatic veins are normal. The inferior vena cava was normal. There was evidence of cholecystectomy. The spleen was enlarged with a span of 18.48 cm however, the flow of the splenic vein is normal. No ascites seen.
Castera transient elastography breakpoint value of 55.6 kPa and controlled attenuation parameter of 131 dB/m was recorded.
Case Discussion
In order to assess stiffness, FibroScan (Vibration-Controlled Transient Elastography) was used with the patient in suspended in inspiration. The stiffness was determined and expressed as a median over 10 acquisitions. B-mode was also employed to interrogate the liver and biliary system. Controlled Attenuation Parameter (CAP) was done, and this provides a standardized non-invasive measure of hepatic steatosis.
Steatosis grading using Thomas Karlas cutoffs (Individual patient data meta-analysis of controlled attenuation parameter (CAP) technology for assessing steatosis:
s0: normal (below 184 dB/m)
s1: mild (184-248 dB/m)
s2: moderate (249-280 dB/m)
s3: severe (above 280 dB/m)
Castera transient elastography breakpoints:
f0 to f1 (2.5 to 7.0 kPa): absent or mild fibrosis
f2 (7.0 to 9.5 kPa): significant fibrosis
f3 (9.5 to 12.5 kPa): severe fibrosis
f4 (above 12.5 kPa): cirrhosis
Body mass index, diabetes, and etiology are found to have significant and relevant influence on controlled attenuation parameter (CAP). CAP of 131dB/m corresponds to steatosis grade S0 (Normal). Using the Castera Transient Elastography Breakpoints, the value of 55.6 kPa corresponds to Metavir classification of f4 liver cirrhosis.
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