Ultrasound Hepatitis

Viral hepatitis
Acute viral hepatitis may be caused by one of several viruses: A, B, C, D or E. The viruses which cause hepatitis B, C and D may also go on to chronic disease and predispose the liver to HCC in the later stages. Vaccines exist for A and B, but not yet for the others. Hepatitis A and E are transmitted via contaminated food or drink and are particularly prevalent in third-world countries. Hepatitis B, C and D are likely to be transmitted through transfusion or sexual contact.
Fulminant hepatitis, in which there is complete liver failure, is a rare complication of acute hepatitis B. Most patients with acute hepatitis recover completely, but hepatitis B, C and D may go on to develop chronic hepatitis. This has two forms:
● Chronic persistent hepatitis is a mild form of inflammation limited to the portal tracts. It is usually of comparatively little clinical significance and does not show ultrasound changes.
● Chronic active hepatitis is a more serious and aggressive form of the disease which causes diffuse, persistent inflammation. This may eventually lead to cirrhosis, which can be associated with HCC.
Other causes of acute hepatitis Acute hepatitis may also occur with many other conditions. The most common of these are alcoholic hepatitis (see alcoholic cirrhosis, above), infectious mononucleosis, herpesvirus and cytomegalovirus. Patients with AIDS and those who are immunosuppressed are also particularly prone to hepatitis.
Clinical features of hepatitis
It may be asymptomatic (patients who have antibodies present, but who deny having had the disease, must have had subclinical disease at one time). Other signs include lethargy, nausea, vomiting and jaundice. The liver is enlarged and tender in the acute phase. The diagnosis and classification of hepatitis must
be made histologically, ideally with an ultrasoundguided biopsy.
Ultrasound appearances of hepatitis
The liver frequently appears normal on ultrasound. In the acute stage, if ultrasound changes are pres ent, the liver is slightly enlarged with a diffusely hypoechoic parenchyma. The normally reflective portal tracts are accentuated in contrast (Fig.below). This ‘dark liver’ appearance is non-specific, and may also occur in leukaemia, cardiac failure, AIDS and other conditions.
The inflammation may start at the portal tracts working outwards into the surrounding parenchyma, the so-called periportal hepatitis. In such cases, the portal tracts become less welldefined and hyperechoic. The gallbladder wall may also be thickened, and some patients demonstrate portal lymphadenopathy.
If the disease progresses to the chronic stage, the liver may reduce in size, becoming nodular and coarse in appearance (Fig. below).

Ultrasound images Subtle changes of oedema in acute hepatitis: the liver is hypoechoic compared with the right kidney, mildly enlarged and has prominent portal tracts.

Ultrasound images Chronic hepatitis and cirrhosis, demonstrating a coarse-textured, nodular liver.

LiveJournal Tags: Ultrasound images Chronic hepatitis and cirrhosis

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1 comment:

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