Transient periportal hyperechogenicity in feverish patients: a novel ultrasonographic finding

Abstract

Purpose Periportal hyperechogenicity has been recorded in many inflammatory and infectious diseases, including viral hepatitis, inflammatory bowel diseases, toxic shock syndrome of staphylococcus infection, typhoid fever, and schistosomiasis. We aimed to evaluate the echogenicity of the portal tracts of the liver by abdominal ultrasound imaging in patients with fever irrespective of the cause. Methods Abdominal ultrasound examination was performed in 277 consecutive patients presented with fever at their first visit and repeated 2 weeks later after their recovery. Results Transient periportal hyperechogenicity was present in 39% (108 patients) of the feverish patients studied irrespective of the cause of the fever. Conclusion Transient periportal hyperechogenicity is a frequent ultrasonographic finding in feverish patients irrespective of the cause of fever, and hence should not be misdiagnosed as liver disease or chronic periportal fibrosis unless the hyperechogenicity persists after recovery from the febrile or inflammatory condition.

Pilot Study: Outcomes of the Full Abdominopelvic Ultrasound Protocol for Diagnosis of Acute Appendicitis in Children: A Retrospective Chart Review

“…Table 2 outlines the specific outcomes of the 18 cases and demonstrates the relationship of overlap between alternative findings and changes in patient management. Alternative US findings included but were not limited to periportal hyperechogenicity (also called “periportal cuffing” and thought to be a nonspecific sign of fever 8 ), fluid-filled bowel loops, prominent RLQ lymph nodes, renal pelvic dilatation, small bowel intussusception, mild hepatosplenomegaly, and bladder debris.…”

A distinct case of an 8-year-old female with cyclic neutropenia presenting with C. septicum abdominal sepsis and myonecrosis requiring a bowel resection and leg fasciotomy

“…At presentation, our patient’s initial ultrasound results demonstrated a starry sky appearance of the liver. Starry sky, also known as periportal hyperechogenic, is a nonspecific finding of abdominal inflammation that is more prominent in pediatric patients [ 7 , 8 ]. The differential is broad but includes a wide range of pro-inflammatory intra-abdominal processes, including but not limited to hepatitis, appendicitis, terminal ileitis, intussusception, gastroenteritis, mesenteric lymphadenitis, and inflammatory bowel disease.…”

Spontaneous Liver Rupture in the Setting of Autoimmune Disease and Periportal Edema

“…Point-of-care ultrasound (POCUS) can visualize features of both impending rupture and hemoperitoneum. For example, although ultrasound is poorly sensitive and specific, it can visualize periportal hyperechogenicity, which can be indicative of inflammatory and infectious pathologies such as viral hepatitis [10]. In the setting of hemoperitoneum, POCUS is more effective, as reflected in the established use of POCUS in the Focused Assessment with Sonography for Trauma (FAST) exam, with sensitivity and specificity values ranging from 63 to 100% and 95 to 100%, respectively [11,12].…”