Acute hepatitis - starry sky appearance

Case contributed by Dr Chris O'Donnell

Presentation

6 weeks of right upper quadrant pain and elevated liver enzymes.

Patient Data

Age: 45 years
Gender: Female
Ultrasound

Tiny echogenic foci throughout the liver. These are within the portal triads and do not represent gas bubbles (as per the CT scan). Appearances are non-specific but most commonly associated with hepatitis (starry night).

No corresponding CT abnormality.

Case Discussion

Acute hepatitis is a clinical and laboratory diagnosis. Starry sky appearance appears as bright echogenic dots throughout a background of decreased liver parenchymal echogenicity. It has poor sensitivity and specificity.

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