The value of ultrasonography in acute viral hepatitis. relationship with severity

Acute viral hepatitis (AVH) is an inflammatory process of the liver involving primarily the parenchyma. The most common etiology is viral infection: A, B, C, D, E, F, G, cytomegalovirus, Epstein-Barr virus, adenovirus, Coxsackie virus. The diagnosis is based on the clinical and biological picture (jaundice-cytolysis). The imagery has the role to exclude other causes of jaundice (obstructive). The ultrasonography, although is routinely used, is not accepted as a useful tool in positive diagnostic of AVH.

Objective: Evaluation of B-mode and Doppler sonographic data obtained in a group of patients confirmed with AVH in different forms of course severity.

Study group: 24 patients, age between 18–44 yr, admitted in the Infectious Diseases Department of our hospital with AVH in the 2006–2007 interval; 8 patients with severe clinical course.

Methods: The ultrasound evaluation included the standard B-mode examination of liver and spleen parenchyma, gallbladder, portal vein tract and distal ramifications. The presence of hilar lymphadenopathy was notified in some cases. The echo-textural data were analyzed by gray-scale histogram. Color and spectral Doppler modes permitted the evaluation of flow in portal tract, hepatic veins, hepatic artery, splenic artery and splenic vein. The spectral-wave envelope parameters were followed-up by serial examinations during the hospitalization and correlated with the pattern of aminotransferases level.

Results: Ultrasonography of liver and spleen in patients with AVH revealed some nonspecific data. The following parameters correlated with clinical and biological picture and a severe course of disease: high level ecogenicity of spleen, hilar limphadenopathy, large portal and splenic veins caliber, high RI in hepatic artery (>0.75) and low RI in splenic artery (<0.55). The spectral envelope parameters modified during the evolution of the disease in relationship with dynamic of jaundice and liver cytolysis. The liver or spleen dimensions and Doppler-wave envelope of hepatic veins did not correlated with clinical course of AVH.

Conclusions: B-mode in association with Doppler ultrasonography offers useful information to follow-up the patients confirmed with AVH, in close relationship with biological course and the severity of clinical picture.