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Starry sky appearance on ultrasound

A "starry sky appearance" refers a particular sonographic appearance where there are bright echo dots throughout the liver parenchyma on ultrasound. 


It is thought to occur due to the intralobular 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  - considered the most common 1
  • toxic shock syndrome
  • leukemic infiltration of liver
  • fasting liver 2
  • Burkitt's lymphoma involving liver 3
  • right heart failure

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