Acute hepatitis - ultrasound

Case contributed by Dr. Ismail Sayed Ismail


Presented to the ER with right hypochondrial pain, a tinge of jaundice and fever. Lab results showed high CRP, significantly elevated liver enzymes (AST, ALT more than 1000), mildly elevated alkaline phosphatase and bilirubin.

Patient Data

Age: 4 years
Gender: Male

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.

Periportal cuffing (thickened, echogenic, edematous periportal tracts).

GB wall thickening with stratification (edema pattern). 

Minimal reactive perihepatic fluid.

Few mildly enlarged reactive porta hepatis lymph nodes.

Case Discussion

Features are suggestive of acute hepatitis. Gallbladder wall edema is the single most sensitive sign when combined with negative sonographic Murphy sign. The use of a higher frequency transducer, such as linear or microconvex transducers, enhances the visualization of subtle findings, especially in children.

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Case information

rID: 65151
Published: 28th Dec 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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