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Starry sky appearance on ultrasound

A "starry sky appearance" refers to a sonographic appearance of the liver parenchyma in which there are bright echogenic dots throughout a background of decreased liver parenchymal echogenicity. Although usually associated with acute hepatitis, this sign has been found to have poor sensitivity and specificity 4.


It is thought to occur due to the oedematous swelling of hepatocytes with a resultant decrease in the hepatic echogenicity. The altered acoustic properties between the portal venous radicals and hepatic lobules cause sonographic accentuation of the venule walls.

This can occur from a range of varying causes:

  • acute hepatitis
  • toxic shock syndrome
  • leukemic infiltration of liver
  • fasting liver 2
  • Burkitt's lymphoma involving the liver 3
  • right heart failure

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Ultrasound - general index

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