A liver ultrasound is a noninvasive test to examine the liver, its blood vessels, and sometimes the gallbladder. Abnormal results may indicate a person has liver disease or signal an issue.

A doctor may recommend a liver ultrasound in the following circumstances:

  • A person has elevated liver enzymes or another abnormal finding on a blood test.
  • A person has several risk factors for liver disease.
  • A person already has liver disease, and a doctor wants to monitor its progress.
  • A person has jaundice, upper right abdominal pain, or other signs of liver disease.

An ultrasound can diagnose some liver diseases, such as nonalcoholic fatty liver disease (NAFLD), and offer further diagnostic guidance for others, such as cancer.

Before having a liver ultrasound, a person should ask the doctor what they are looking for on the scan, how long they will have to wait for results, and whether additional testing will be necessary if the test reveals abnormal results.

Read on to learn about abnormal liver ultrasounds, including what they can mean, how they differ from normal results, and their causes.

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A doctor may recommend a liver ultrasound when a person shows signs of liver disease. This might include elevated liver enzymes on a blood test, jaundice, or unexplained pain in the upper right abdomen. Some doctors may also recommend an ultrasound to monitor the progression of liver disease.

A liver ultrasound is not a binary test that produces a yes/no or positive/negative answer. Instead, it uses sound waves to visualize the liver, its blood vessels, and associated structures such as the gallbladder.

The meaning of an abnormal liver test depends on what a doctor finds. In most cases, abnormal results will require additional testing.

Doctors or radiologists may look at the surface and texture of the liver. They may also examine areas that appear brighter on the scan.

They will assess findings based on an individual basis and determine the course of action.

Results from the liver ultrasound can either show up normal or abnormal:

Normal

Normal liver ultrasound results may show:

  • little or no fatty deposits in the liver
  • no unusual growths or lesions
  • no blockages of any of the liver’s veins or ducts
  • no blockages or gallstones in the gallbladder
  • no significant scarring
  • a normally sized liver with no swelling

Some people with liver dysfunction may still have a normal scan, and other tests may be helpful to determine the cause of the disease.

Abnormal

Abnormal liver ultrasounds may find one or more of the following structural changes:

  • Liver size changes: This could be a sign of several underlying diseases, including acute infections. A doctor may look at other signs, such as blood tests or other results from the ultrasound, to determine the reason for the enlargement.
  • Fat deposits: These fat deposits may appear brighter on scans.
  • Scarring or fibrosis: This can indicate liver damage.
  • Lesions and growths: A liver ultrasound may show lesions or growths that could indicate tumors.
  • Blockages: Ducts or blood vessels of the liver could have blockages. This could be from an infection or an underlying disease. It may also be a sign of cardiovascular disease.
  • Bile duct changes: This may show a block in the bile ducts, which can cause pain. Over time, repeated gallstone blockages may cause inflammation or scarring of the liver.
  • Inflammation: This could indicate an underlying disease.

Some of the most common findings of abnormal liver ultrasounds include:

Scarring

Liver fibrosis is scarring of the liver. Large amounts of scarring suggest that a person may have chronic liver disease, such as:

  • unmanaged NAFLD
  • untreated hepatitis
  • chronic alcohol use disorder

Liver nodules and growths

Growths and lesions on the liver could be a sign of liver cancer. Sometimes people develop these lesions in their liver when cancer from another part of the body metastasizes to the liver.

There are also noncancerous, or benign, liver lesions that show up on an ultrasound. These benign lesions may or may not require additional testing, depending on their characteristics.

Fatty liver

NAFLD means that there are abnormal fatty deposits in the liver. Over time, this can cause liver inflammation and scarring.

It is very common, and most people with NAFLD do not have symptoms. However, the disease may worsen without lifestyle changes, especially in people with other liver disease risk factors such as excessive alcohol use.

Alcohol-related liver damage

Alcohol, especially chronic alcohol use disorder, can cause scarring and damage to the liver. Over time, this may limit the liver’s ability to function. People who misuse alcohol may have liver ultrasounds that show scarring or inflammation.

Gallstones

Although it is not part of the liver, damage to the gallbladder may affect the liver. This is especially true when there is a blockage in the common bile duct, a structure found in the gallbladder.

An ultrasound may show gallstones blocking the bile duct. A doctor may also look for gallstones in the gallbladder since this is a common cause of pain in the upper stomach and elevated liver enzymes.

Hepatomegaly

An enlarged liver, or hepatomegaly, can happen for many reasons. These can include infection or blockage, or chronic liver disease.

For example, unmanaged NAFLD may cause the liver to become enlarged. An enlarged liver may cause pain, work less well, or eventually lead to liver failure.

The next steps depend on what the ultrasound shows. The next steps might include:

  • Treatment: Some conditions require prompt treatment. If a person has symptomatic gallstones or gallstones blocking a duct, a doctor may recommend removing the gallbladder.
  • Additional testing: An ultrasound can narrow down the list of potential problems but may not diagnose all issues. In some cases, a person might need additional tests, such as a liver biopsy, to identify the cause of the liver disease.
  • Monitoring: A doctor may recommend monitoring the progression of a condition such as NAFLD with regular liver tests.

Treatment

Treatment depends on the diagnosis a doctor uncovers. Some potential treatment options include:

People should ask their healthcare professionals about what they can expect following their test.

The liver is a vital organ that a person needs to survive. Liver disease is serious, as are any risk factors for liver disease. For this reason, a doctor may recommend a liver ultrasound to someone who shows any signs of liver disease.

A liver ultrasound might produce abnormal results in a person with liver conditions or dysfunction. A person should ask the doctor what to expect from the test, whether they will need additional testing, and what the best and worst case scenarios might be.