“Bright Band Sign” A Grayscale Ultrasound Finding in Hepatic Infarction

Abstract

Hepatic infarction is infrequent due to the dual blood supply of the liver and the compensatory relationship between the hepatic artery and portal vein. Most cases occur in liver transplants due to vascular complications. Grayscale sonography combined with color and spectral wave Doppler can assess for vessel patency and parenchymal abnormalities. Liver infarctions appear as hypoechoic nonvascular regions on conventional and Doppler sonography. Here, we describe a grayscale ultrasound feature within liver infarctions in 2 liver transplants and in 1 native liver due to iatrogenic complication. This feature is similar to those described recently in the literature within splenic infarcts.

Comments and illustrations of the WFUMB CEUS liver guidelines: Rare vascular pathology, part II

“…After liver transplantation, most liver infarctions occur due to vascular typical complications [49,50]. Vascular complications in the early postoperative period occur in approximately 9% of liver transplanted patients.…”

“…The localization of hepatic infarction is frequently described in the right hepatic lobe [28,33,36,39,45,49,60], but can also occur in the left hepatic lobe [48] and may be multifocal particularly in the peripheries of both lobes [43,49,55,61]. Localization to the caudate lobe has also been reported [62].…”

“…However, the diagnosis of an ischemic injury on B-mode US alone is difficult in many cases, especially immediately after the acute event [64]. Typically, they are described as wedge-shaped, well-circumscribed or rounded hypoechoic regions and maybe located in the periphery or centrally [49].…”

Ultrasonographic evaluation of patients with abnormal liver function tests in the emergency department

“…Hepatic infarct occurs due to acute hepatic hypoperfusion secondary to systemic hypotension or hepatic artery occlusion from thrombosis or embolism [ 49 ]. Liver enzymes may be markedly elevated [ 50 ].…”

“…A wedge-shaped, ill-defined, hypoechoic region is the typical appearance ( Fig. 20 ) [ 49 ]. More diffuse and heterogeneous involvement can be observed in patients with systemic hypoperfusion or shock liver.…”