A 30-year-old man is referred to ultrasound forgeneralized right upper quadrant tenderness andearly signs of jaundice. His gallbladder appearsnormal, but there are bright focal areas withoutshadowing scattered throughout his liver. Onclose inspection, these areas are seen to be thewalls of the portal vein branches. What is first inthe list of differential diagnoses?
A. Hepatitis B. Choledocholithiasis C. Pneumobilia
Hepatitis-jaundice brings to mind obstruction from
choledocholithiasis, but with an absence of gallstones
or shadowing throughout the liver a nonobstructive
cause should be considered. a subtle increase
in echogenicity of the portal triads is one of
the few sonographic indications of hepatitis; however,
this finding is not always present. it is possible
that the increase in periportal echogenicity is
caused by the decreased parenchymal echogenicity
sometimes seen in hepatitis. pneumobilia would
cause linear echogenicity with dirty shadowing.
choledocholithiasis would be seen as one or more
echogenic densities with acoustic shadowing.