Acute hepatitis - ultrasound

Case contributed by Dr. Ismail Sayed Ismail

Presentation

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.

Patient Data

Age: 4 years
Gender: Male
Ultrasound

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.

Case Discussion

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.

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Case information

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

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