Acute hepatitis - ultrasound
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.
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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.
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.
3 case question available
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.