Presentation
Right hypochondrial abdominal pain, vomiting and fever for 5 days.
Patient Data
Liver is homogeneously enhanced with liver enlargement (18.5cm in midclavicular line). Liver has smooth and regular edge and margin. Diffusely decreased liver parenchymal attenuation relative to that of spleen parenchyma. Perihepatic fat stranding. Portal veins and hepatic veins are patent. No periportal hypodensity to suggest periportal edema.
Gallbladder is partially distended with mildly thickened gallbladder wall and pericholecystic fluid. Biliary tree is normal.
Fat stranding at the retroperitoneum, especially near to the second and third part of duodenum, where the D2 and D3 duodenal wall appear thickened. No other obvious bowel related mass, bowel wall thickening or bowel loops dilatation.
Mild degree of fluid attenuated (5 to 10 HU) ascites at the perihepatic, bilateral paracolic gutters, pelvis and perisplenic regions. No abnormal peritoneal enhancement.
Thickening of bilateral anterior pararenal fascia, lateral conal fascia and right posterior pararenal fascia. Increased right perinephric fat stranding. However, right kidney enhanced homogeneously. No focal renal/perinephric collection or lesion. No hydronephrosis and hydroureter bilaterally.
Spleen and pancreas are normal.
Minimal bilateral pleural effusion and pericardial effusion.
Case Discussion
Patient has positive dengue serology (NS-1 antigen, dengue IgG/IgM) where dengue fever is endemic disease in this part of world. The serum laboratory values of liver function test are all elevated (AST, ALT, bilirubin) with reduction of serum albumin.
The diagnosis of acute hepatitis is usually made on clinical ground together with laboratory results. CT imaging features of acute hepatitis are usually non specific but can aid in diagnostic confidence such as depicted in this case.
Hepatomegaly, diffusely decreased attenuation of liver parenchyma and perihepatic stranding are some of the imaging features.