Sonographic findings of acute hepatitis in the emergency department

Abstract

Viral hepatitis is a common cause of upper abdominal pain, vomiting, and abnormal liver function tests. In 2018, there was an outbreak of hepatitis A cases in southwestern Ohio, one of many across the United States in recent years. Viral hepatitis can demonstrate impressive gallbladder wall edema and thickening on ultrasound imaging. We describe a case series where marked gallbladder wall thickening was noted on point-of-care ultrasound and either led to the correct diagnosis or prompted some diagnostic uncertainty. In an undifferentiated patient, this may confuse the clinical picture because most emergency physicians may not be aware of this finding.

New Developments in the Ultrasonography Diagnosis of Gallbladder Diseases

“…In case of acute hepatitis, especially viral etiology, gallbladder wall edema is often associated with biliary sludge, hepatomegaly and the diffusely hypoechoic texture of the liver, sometimes with prominent portal triads ("starry sky" appearance) [178].…”

“…The sonographic hallmark of gallbladder edema is the presence of wall thickening (>3 mm) with a multilayered and meshwork pattern [166]. A double-wall appearance can be seen, characterized by the presence of hyperechoic outer and inner borders with a relatively narrower echogenic layer in between [178]. Gallbladder edema can be misdiagnosed with the pseudo-thickening observed in the post-prandial state due to the gallbladder physiologic contraction [166].…”

Current Status and New Developments in the Ultrasonography Diagnosis of Gallbladder Diseases

“…[199][200][201][202][203][204][205][206][207] In case of acute hepatitis, especially of viral etiology, gallbladder wall edema is often associated with biliary sludge, hepatomegaly and diffusely hypoechoic texture of the liver, sometimes with prominent portal triads ("starry sky" appearance). [208,209] The sonographic hallmark of gallbladder edema is the presence of wall thickening (> 3 mm) with a multilayered and meshwork pattern. [196] A double-wall appearance can be seen, characterized by the presence of hyperechoic outer and inner borders with a relatively less echogenic layer in between.…”

“…[196] A double-wall appearance can be seen, characterized by the presence of hyperechoic outer and inner borders with a relatively less echogenic layer in between. [208] Gallbladder edema can be misdiagnosed with the pseudo-thickening observed in the post prandial state, due to the gallbladder physiologic contraction. [196] CEUS could be useful to differentiate gallbladder wall edema from gallbladder wall thickening due to AC.…”