Starry sky appearance (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.


This ultrasound sign should not be confused with the similarly named starry sky appearance (MRI) seen in multiple biliary hamartomas and the milky way sign (MRI) seen in progressive multifocal leukoencephalopathy (PML). 


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

Inspired signs

Article information

rID: 22775
Section: Signs
Synonyms or Alternate Spellings:
  • Starry sky appearance - ultrasound
  • Starry night appearance on ultrasound
  • Hepatic starry sky appearance - ultrasound
  • Hepatic starry night appearance - ultrasound
  • Starry sky appearance - ultrasound liver

ADVERTISEMENT: Supporters see fewers/no ads

Cases and figures

  • Case 1
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.