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Acute hepatitis (plural: acute hepatitides) occurs when the liver suffers an injury with a resulting inflammatory reaction. The cause of the injury can happen in multiple different ways, and imaging findings are often non-specific. Acute hepatitis is a clinical diagnosis and a normal imaging appearance of the liver does not exclude it 7.
The incidence of acute hepatitis depends on the etiology.
Patients often present with fever, abdominal pain, and jaundice. Multiple serum lab values are often elevated, including AST, ALT, and GGT. Depending on the degree of liver injury, lab values may indicate depressed liver function (e.g. decreased albumin). If the hepatitis is a result of viral infection, specific serum immunologic markers may be present (e.g. anti-HAV IgM indicates active hepatitis A infection).
Acute hepatitis is a general term encompassing diffuse hepatocyte injury with resulting inflammatory change. The entire liver may be involved, or only portions of it.
Histologically, acute hepatitis manifests as a lobular hepatocellular injury with features of hepatocellular swelling, apoptosis, or loss.
Six morphologic subpatterns of acute hepatitis are described:
inflammation predominant pattern
giant cell pattern
mild nonspecific pattern
other infections (e.g. parasites) 9
drug/toxin-induced hepatitis (e.g. acetaminophen toxicity, alcohol) 9
ischemic (e.g. systemic shock, Budd-Chiari syndrome) 9
primary graft dysfunction after liver transplantation 9
Described features include:
hepatomegaly (most sensitive sign)
>15.5 cm at the midclavicular line 4
starry sky appearance has been found to have poor sensitivity and specificity 2
may be more closely associated with hepatitis A
accentuated brightness of portal vein radicle walls
color/spectral Doppler: normal
the overall echotexture is often decreased 5,6
Not a first line imaging modality for evaluation. Findings include:
>15.5 cm at the midclavicular line 4
possible decreased attenuation around the portal system and at the hepatic hilum (periportal edema)
possible diffusely decreased parenchymal attenuation on noncontrast CT
diffuse edematous change
hepatic steatosis may be a cause (steatohepatitis) or a result of acute hepatitis
possible periportal/hepatoduodenal lymphadenopathy
Findings on MRI are non-specific, and MRI is often used to exclude other etiologies of deranged serum liver function tests:
increased T2 signal around the portal system (periportal edema)
possible mild generalized increase in parenchymal signal intensity
T1 C+ (Gd):
delayed, gradual periportal enhancement
hepatic steatosis may be apparent
Autoimmune hepatitis does not usually present with lymphadenopathy.
Treatment and prognosis
Treatment depends on the etiology of acute hepatitis.
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