Which finding may be seen on ultrasound with acute hepatitis?

Which finding may be seen on ultrasound with acute hepatitis?

• A. The liver parenchyma remains normal with regular portal borders
• B. The liver parenchyma may be hyperechoic with attenuated beam and a thickened gallbladder wall
• C. The liver parenchyma is isoechoic with no other changes
• D. The liver parenchyma may be hypoechoic, portal vein borders may be more echogenic than normal, with attenuation; hepatosplenomegaly, thickened gallbladder wall, and elevated AST, ALT, bilirubin

Answer: (D)

Acute hepatitis often causes inflammatory edema in the liver, leading to a less uniform, sometimes hypoechoic liver with possible mild hepatomegaly. Edema around the vessels can make the portal vein borders appear more echogenic, and the ultrasound beam can be attenuated as it passes through edematous tissue. The inflammatory process can extend to involve the gallbladder wall, causing thickening, and there may be associated hepatosplenomegaly. Lab tests typically show elevated AST and ALT with increased bilirubin, reflecting hepatocellular injury and cholestasis. The described finding fits this pattern: a liver that is hypoechoic with more echogenic portal borders and beam attenuation, along with hepatosplenomegaly, thickened gallbladder wall, and elevated liver enzymes. This constellation aligns with acute hepatitis rather than a normal liver appearance, a uniformly hyperechoic parenchyma, or an isoechoic liver with no other changes.

Acute hepatitis often causes inflammatory edema in the liver, leading to a less uniform, sometimes hypoechoic liver with possible mild hepatomegaly. Edema around the vessels can make the portal vein borders appear more echogenic, and the ultrasound beam can be attenuated as it passes through edematous tissue. The inflammatory process can extend to involve the gallbladder wall, causing thickening, and there may be associated hepatosplenomegaly. Lab tests typically show elevated AST and ALT with increased bilirubin, reflecting hepatocellular injury and cholestasis.

The described finding fits this pattern: a liver that is hypoechoic with more echogenic portal borders and beam attenuation, along with hepatosplenomegaly, thickened gallbladder wall, and elevated liver enzymes. This constellation aligns with acute hepatitis rather than a normal liver appearance, a uniformly hyperechoic parenchyma, or an isoechoic liver with no other changes.