Sonographic evaluation of liver (Normal size of liver on ultrasound )

Sonographic evaluation of hepatobiliary system

The Hepatobiliary system consists of the liver, gallbladder, bile ducts, and associated vasculature. Ultrasound is the primary imaging modality for


Sonographic evaluation of liver: Liver ultrasound is a first-line imaging modality used to assess the liver’s size, shape, echotexture, vascular structures, and pathological conditions. It is non-invasive, cost-effective, and provides real-time imaging, often supplemented with Doppler ultrasound for vascular evaluation.

A.     Liver Size and Shape

Rt. Lobe Liver            <140mm ±17mm. MCL

Left lobe AP diameter <70mm

Caudate lobe AP diameter<30mm

Main PV          

 <13mm

 

Main HV

5mm-15mm

Main HA

5-8mm

Capsular thickening greater than 3 mm can be considered abnormal and may suggest an underlying liver condition.








➤Normal Ultrasound Mid-Clavicular Length of Liver by Age

Newborns and Infants (0-2 years):

45-60mm

Children (3-12 years):

60-80mm

Adolescents (13-18 years):

80-110mm

Adults (18+ years):

120-150mm








➤The normal sonographic AP diameter of the left lobe of the liver varies slightly depending on body size and individual anatomy, but typical reference ranges for

the left lobe include:

Newborns and Infants (0-2 years):

15-20mm

Children (up to 10 years):

15-40mm

Adolescents (13-18 years):

30-50mm

Adults (18+ years):

40-60mm







➤The normal sonographic anterior-posterior (AP) diameter of the caudate lobe of the liver varies with age, though the caudate lobe is typically smaller in comparison to other liver lobes. Here's a general guideline based on age:

Newborns and Infants (0-2 years):

15-20mm

Children (up to 10 years):

15-30mm

Adolescents (13-18+ years):

20-40mm

 

 

  • Hepatomegaly: >150MM (common in fatty liver, heart failure, infections, malignancy, Acute/ Fulminate liver failure).
  • Liver Atrophy: Seen in cirrhosis, chronic liver disease.
B. Liver Echotexture and Echogenicity

·         Normal: Homogeneous.

·         Increased Echogenicity (Hyperechoic) → Fatty liver, cirrhosis, chronic hepatitis.

·         Decreased Echogenicity (Hypoechoic) → Acute hepatitis, lymphoma, metastases.

·         Nodular Surface → Cirrhosis and fibrosis.


C. Liver Lesions (Focal Abnormalities)

·         Cysts – Anechoic (dark), well-defined, posterior acoustic enhancement.

·         Hemangiomas – Hyperechoic (bright), well-circumscribed, common benign lesion.

·         Hepatocellular Carcinoma (HCC) – Hypoechoic or mixed echogenic, irregular borders.

·         Metastases – Variable appearance; often hypoechoic with a halo.

·         Abscesses – Complex, hypoechoic, may have gas bubbles with dirty shadowing.


D. Vascular Structures (Doppler Ultrasound)

Normal portal vein Diameter on Ultrasound by Age.Normal diameter ≤13 mm, hepatopetal

flow (toward the liver).

Portal vein Diameter on Ultrasound by Age

➤Common portal vein

The normal diameter of the common portal vein can vary slightly by age. Below are the typical

reference ranges:

Newborns and Infants (0-2 years):

6-7mm

Children (3-12 years):

7-8mm

Adolescents (13-18 years):

8-10mm

Adults (18+ years):

7-13mm







➤Right portal vein

The normal diameter of the right portal vein can also vary based on age, though

measurements for this vein are often less commonly referenced separately from the main portal

vein. However, based on general trends for the portal veins in general, here’s an approximate

breakdown of the right portal vein diameter according to age.

Newborns and Infants (0-2 years):

4-6mm

Children (3-12 years):

6-8mm

Adolescents (13-18 years):

8-10mm

Adults (18+ years):

7-11mm






The right portal vein, like the main portal vein, can expand or contract in certain pathologies such as portal hypertension. The measurements above are typical for healthy individuals.

➤Mid portal vein

Newborns and Infants (0-2 years):

5-6mm

Children (3-12 years):

6-8mm

Adolescents (13-18 years):

8-10mm

Adults (18+ years):

7-13mm








➤Left portal vein
The left portal vein, like the other sections of the portal vein, has a diameter that varies according to age. Although specific references for the left portal vein are less commonly noted separately, it generally follows the same trends as the main portal vein and the right portal vein:

Newborns and Infants (0-2 years):

4-6mm

Children (3-12 years):

6-8mm

Adolescents (13-18 years):

8-10mm

Adults (18+ years):

7-11mm







The left portal vein diameter may also be considered abnormal if it exceeds 11mm in adults, indicating potential issues like portal hypertension or other liver-related conditions.
  • Portal Hypertension: Dilated vein (>13 mm) reversed flow (hepatofugal).

Normal Hepatic vein Diameter on Ultrasound by Age 
➤Common Hepatic vein: The normal diameter of the common hepatic vein can vary with age. While specific values may differ slightly based on the source and individual variations, here’s a general guideline for the main hepatic vein's diameter based on age:

Newborns and Infants (0-2 years):

3-6mm

Children (3-12 years):

4-8mm

Adolescents (13-18 years):

6-10mm

Adults (18+ years):

8-15mm





In general, the right hepatic vein is typically the largest of the hepatic veins. As with the main

hepatic vein, variations can occur due to body size, liver anatomy, and health status. If the

diameter exceeds 12mm in adults or shows marked differences from typical measurements, it

might warrant further investigation.

➤Right hepatic vein: The normal diameter of the Right hepatic vein (RHV) can vary depending.

on the age of the individual. Here is a general guideline:

Newborns and Infants (0-2 years):

3-6mm

Children (3-12 years):

4-7mm

Adolescents (13-18 years):

5-10mm

Adults (18+ years):

6-12mm

 

 

 

 

 ➤Middle hepatic vein: The normal diameter of the Middle hepatic vein (MHV) varies with age. While there may be slight variations based on individual factors, here is a general guideline for the normal diameter of the middle hepatic vein based on age:

Newborns and Infants (0-2 years):

3-6mm

Children (3-12 years):

4-7mm

Adolescents (13-18 years):

5-10mm

Adults (18+ years):

6-12mm







In general, the middle hepatic vein’s diameter is slightly smaller compared to the right hepatic vein but can still be variable depending on factors like liver anatomy, body size, and health conditions. If the diameter exceeds the typical range (especially greater than 12mm in adults), it may warrant further investigation into liver function or potential vascular conditions.
➤Left hepatic vein: The normal diameter of the Left hepatic vein (LHV) varies based on age. Here is an approximate guideline for its normal diameter by age group:

Newborns and Infants (0-2 years):

2-4mm

Children (3-12 years):

3-6mm

Adolescents (13-18 years):

4-8mm

Adults (18+ years):

5-10mm






The left hepatic vein is typically smaller in diameter compared to the right hepatic vein. If the left hepatic vein's diameter exceeds 10mm in adults, it could suggest an abnormality or underlying condition such as liver disease or vascular obstruction.
  • Hepatic Veins: Should have a triphasic waveform; abnormal in Budd-Chiari syndrome
Normal Hepatic Artery Diameter on Ultrasound by Age 

Newborns and Infants (0-1 years):

1.0–2.5 mm

Infants & Toddlers (1–5 years):

2.0–3.5 mm

Older Children (6–12 years):

3.0–4.5 mm

Adolescents (13-18 years):

3.5–5.0 mm

Adults (18+ years):

3-5mm








Proper Hepatic Artery (PHA) Diameter: 3–6 mm (average ~4.5 mm)
Common Hepatic Artery (CHA) Diameter: 4–7 mm.

•  Resistive Index (RI): 0.55–0.8

•  Peak Systolic Velocity (PSV): 80–120 cm/s

Hepatic Artery: Assessed for stenosis, aneurysms, or thrombosis.

 Clinical Applications of Liver Ultrasound

✅  Fatty liver disease (steatosis), cirrhosis, and fibrosis evaluation.
✅  Diagnosis of liver tumors (HCC, metastases, hemangiomas, cysts).
✅  Assessment of portal hypertension, ascites, and hepatic vascular flow.
✅  Detection of biliary obstruction and bile duct abnormalities.
✅  Evaluation of trauma-related liver injuries.

✅ Liver ultrasound, enhanced with Doppler imaging, is a key tool for diagnosing and monitoring liver diseases, vascular conditions, and hepatobiliary disorders.

Normal liver



Hepatomegaly: >150MM (common in fatty liver, heart failure, infections, malignancy, Acute/ Fulminate liver failure).

Fatty liver [Hepatic steatosis]
Fatty grade-i.

Liver Atrophy: Seen in cirrhosis, chronic liver disease
Liver cirrhosis

Chronic liver disease






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