Acute hepatitis - ultrasound
A child presented to ER with right hypochondrial pain, tinge of jaundice and fever. Lab. results showed high CRP, significantly elevated liver enzymes (AST, ALT > 1000), mildly elevated alkaline phosphatase and bilirubin.
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The liver size is relatively large for corresponding age suggesting edema/congestion (its inferior margin passed lower pole of the right kidney in LS view).
Liver echogenicity is slightly decreased with homogenous echotexture.
Peri-portal cuffing (thickened echogenic edematous peri-portal tracts).
GB wall thickening with stratification (edema pattern).
Minimal reactive peri-hepatic fluid.
Few mildly enlarged reactive porta hepatis lymph nodes.
3 case question available
Features are suggestive of acute hepatitis. Gallbladder wall edema is the most sensitive single sign with -ve sonographic Murphy's sign. The use of a higher frequency transducer enhances the visualization of subtle findings, like using linear or microconvex transducers, esp. in children.