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]

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:

• Splenomegaly
• Ascites
• Pleural effusion
• Reversed flow

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.