Persistent Heterogeneous Liver Enhancement after US Contrast Material Injection

Unusual Progressive Hepatic Echogenicity of the Pediatric Liver Following Intravenous Sonographic Contrast Administration

“…Unusual progressive hepatic echogenicity in this series of pediatric patients was noted as early as 1 minute following contrast injection, whereas prior accounts from the adult literature describe PHLE as occurring at 2 minutes or later. 3–8 This phenomenon was observed in three children over a 2-year time period out of approximately 35 CEUS abdominal examinations (~9%) compared to the much lower rates described in the adult literature, which range from 0.001% to 0.4%. 3,4,6,7 These clinically fragile and younger patients may be more susceptible to UPHE, and the phenomenon may be observed earlier in children than in adults due to rapid contrast circulation in small patients.…”

“…This mechanism does not explain early appearance of the findings in the third patient case, however. No adverse effects have been reported in the presence of UPHE/PHLE, 4–6 with the exception of the case of a 28-year-old woman who experienced “general discomfort and a transient skin rash.” 8 The patients presented suffered no observable clinical changes from the CEUS examination, although it is important to exercise caution in neonates and unstable patients who may be more susceptible to microvascular effects. Animal studies have demonstrated various bioeffects of UCAs, albeit at up to 50 times clinical dosing and with high MI insonation.…”

“…As discussed below, the etiology of this phenomenon is unlikely to be related to prolonged liver enhancement; therefore, the term "unusual progressive hepatic echogenicity" (UPHE) is proposed. Although the phenomenon in adults is felt by most authors to be benign in nature with no implications regarding underlying liver disease, it has been observed in patients with liver disease [3][4][5][6][7] and in one patient with lactose intolerance. 8 These authors' experience with three medically complex pediatric patients raises the possibility of a pathologic mechanism underlying this phenomenon.…”

“…inflammatory bowel disease, graft vs host disease); and gaseous dissection through the mediastinum and across the gastric wall (i.e., pulmonary disease). [3][4][5][6] Similarly, proposed mechanisms for UPHE include intravasation of intestinal luminal gas resulting in enterohepatic circulation. It has also been proposed that microbubble expansion or aggregation related to the CEUS procedure itself may lead to sinusoidal retention or microvascular occlusion.…”

“…inflammatory bowel disease, graft vs host disease); and gaseous dissection through the mediastinum and across the gastric wall (i.e., pulmonary disease). 3–6…”