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Abdomen » Hepatobiliary
Diffuse Hepatic Parenchymal Disease with Portal Hypertension and Splenomegaly.
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Author(s) :
Leandro Fernandez, MD
 
Presentation 54 year old female patient, with altered hepatic function laboratory tests. Previous episode of upper digestive tract bleeding.
 
 
 
Caption:  Longitudinal view, right hypochondrium on anterior axillar line.
Description: The sonogram shows diffuse changes of the echo-architecture of the right hepatic lobe which is heterogeneous with alternating areas of low and high echogenecity. There is an incipient macronodular pattern.
 
 
 
Caption: Oblique view, right hypochondrium on anterior axillar line
Description: This Color Doppler ultrasound image demonstrates lumen pattency and hepatopetal flow in the portal vein. The Spectral Analysis shows decreased time-averaged velocity (TAM) in this vessel with value of 5.9 cm/s, indicating an abnormal hepatic hemodynamic behavior.
 
 
 
Caption: Longitudinal view left med axillar line. Extended field-of-view ultrasound
Description: By using the extended field-of-view technique, the ultrasound shows an enlarged spleen. Some tubular and round anechoic images correspond to dilated venous vessels as a result of collateral circulation
 
 
 
Caption: Longitudinal view of left hypochondrium.
Description: The Color Doppler ultrasound depicts bidirectional flow in the spleen hilar vessels corresponding to dilated veins.
 
Differential Diagnosis
  1. Hepatic Steatosis (Fatty Liver).
  2. Schistossomiasis
  3. Chronic Hepatitis
  4. Diffuse Hepatic Parenchymal Disease
 
Final Diagnosis Diffuse Hepatic Parenchymal Disease with Portal Hypertension and Splenomegaly.
(Chronic Hepatitis C) 
 
Discussion

The prevalence of hepatitis C virus infection is increasing worldwide. Chronic infection with this virus is one of the most important causes of chronic liver disease. Hepatitis C represents a global epidemic as well, with an estimated 120 million infected individuals worldwide (2% of the world population).

There are no specific ultrasonographic findings for this disease in B mode, but ultrasound helps to identify changes in the echo-architecture which affect all the liver parenchyma.

Duplex Ultrasound, Color Doppler and Power Doppler Imaging are the modalities of choice in the evaluation of the liver and Portal Hypertension. These techniques are noninvasive, rapid, and highly sensitive and specific.

The use of Color Doppler contributes to demonstrate the altered hemodynamic pattern of the portal vein such as slow flow and even reverse flow. The time-averaged velocity usually is on the order of 12-14 cm/s in adults and a value less than 12 cm/s indicates Portal Hypertension.

 
Case References

Ratti L et al. Pathophysiology of portal hypertension in HCV-related cirrhosis. Putative role of assessment of portal pressure gradient in Peginterferon-treated patients. Dig Liver Dis.  2005; 37(11):886-93 

 Cerri GG, Oliveira Ilka. Ultra-Sonografia Abdominal. Revinter, Rio de Janeiro, 2002 p 91

 
Technical Details ATL HDI 5000 ultrasound system with a C5-2 (5 to 2 Mhz) curved linear transducer
 
Follow Up Hepatic biopsy and serology confirmed hepatic cirrhosis and Hepatitis C. Endoscopy of upper gastrointestinal tract showed esophageal varices.
 
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