Hepatitis D ultrasound

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [2]; João André Alves Silva, M.D. [3] Jolanta Marszalek, M.D. [4]

Overview

The liver ultrasound of a patient with hepatitis D may reveal unspecific findings, such as: hepatomegaly, gallbladder wall thickening, increased echogenicity, and signs of portal hypertension. It may also be used in the diagnosis and monitoring of hepatic cirrhosis, as well as for hepatocellular carcinoma. Attending to the simultaneous occurrence of HDV and HBV, HBsAg carriers with cirrhosis should be echographically evaluated every 6 months.^[1]

Ultrasound

Although unspecific, the following findings may be identified in patients with hepatitis D:^[1]^[2]^[3]^[4]

Hepatomegaly (acute phase)
Irregular thickening of the gallbladder wall, often due to inflammation and edema (more frequent in hepatitis A)
Increased echogenicity
Segmental hypertrophy with nodular appearance of the liver
Portal hypertension:

In advanced stages of the disease, in which cirrhosis might be present, the following findings may be identified:

Liver shape abnormalities
Parenchymal heterogeneity
Nodularity of liver surface

HBsAg carriers should have regular determinations of serum alpha-fetoprotein. Ultrasound examinations should be performed in patients above 40 years of age (with 6 month intervals). These tests should be repeated regularly in all patients who are HBsAg positive, with cirrhosis.^[1]

Ultrasound is also useful for the diagnosis and monitoring of hepatocellular carcinoma, a potential complication of hepatitis D.

References

↑ ^1.0 ^1.1 ^1.2 “Hepatitis D” (PDF).
↑ Ferral H, Male R, Cardiel M, Munoz L, Quiroz y Ferrari F (1992). “Cirrhosis: diagnosis by liver surface analysis with high-frequency ultrasound”. Gastrointest Radiol. 17 (1): 74–8. doi:10.1007/BF01888512. PMID 1544561.
↑ Kok T, van der Jagt EJ, Haagsma EB, Bijleveld CM, Jansen PL, Boeve WJ (1999). “The value of Doppler ultrasound in cirrhosis and portal hypertension”. Scand J Gastroenterol Suppl. 230: 82–8. PMID 10499467.
↑ Tchelepi H, Ralls PW, Radin R, Grant E (2002). “Sonography of diffuse liver disease”. J Ultrasound Med. 21 (9): 1023–32, quiz 1033-4. PMID 12216750.

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[WHO1-1] 1.0 ^1.1 ^1.2 “Hepatitis D” (PDF).

[pmid1544561-2] Ferral H, Male R, Cardiel M, Munoz L, Quiroz y Ferrari F (1992). “Cirrhosis: diagnosis by liver surface analysis with high-frequency ultrasound”. Gastrointest Radiol. 17 (1): 74–8. doi:10.1007/BF01888512. PMID 1544561.

[pmid10499467-3] Kok T, van der Jagt EJ, Haagsma EB, Bijleveld CM, Jansen PL, Boeve WJ (1999). “The value of Doppler ultrasound in cirrhosis and portal hypertension”. Scand J Gastroenterol Suppl. 230: 82–8. PMID 10499467.

[pmid12216750-4] Tchelepi H, Ralls PW, Radin R, Grant E (2002). “Sonography of diffuse liver disease”. J Ultrasound Med. 21 (9): 1023–32, quiz 1033-4. PMID 12216750.

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