Cirrhosis Ultrasound Findings

Cirrhosis can be effectively assessed using ultrasound, which reveals several characteristic features. In patients with cirrhosis, the liver often appears smaller in overall size, with an imbalanced ratio between the left and right lobes. When the right lobe undergoes atrophy, the left lobe may enlarge compensatorily, sometimes accompanied by an enlarged caudate lobe. The fissure between the two lobes widens, and the liver surface becomes irregular and nodular.

On ultrasound imaging, the echotexture of the liver parenchyma appears heterogeneous, giving a nodular appearance. Additionally, the portal vein within the liver may show signs of dilation, while the gallbladder wall thickens—sometimes with visible edema. Enlargement of the spleen is also common, along with a dilated and tortuous splenic vein, indicating increased portal pressure.

In decompensated cirrhosis, especially when ascites develops, ultrasound can detect fluid-filled spaces around the liver and spleen, appearing as hypoechoic areas. Although ultrasound is generally sensitive for diagnosing advanced cirrhosis, it may not always provide clear results during the early stages. In such cases, transient elastography can be used to measure liver stiffness. A liver stiffness value greater than 17 kPa typically indicates stage 4 fibrosis, confirming the presence of cirrhosis.

This diagnostic approach enhances accuracy, particularly when ultrasound findings are inconclusive, allowing for earlier detection and better management of liver disease.