RESEARCH

 1. SONOGRAPHIC SYMPATHETIC HEPATITIS

2). MAXILLARY SINO-SONOGRAPHY  

1. SONOGRAPHIC SYMPATHETIC HEPATITIS

                                                         BY 

                                                              DR.M.ADINARAYANA RAO M.D. 

What is sonographic sympathetic hepatitis? 
What are the Sonographic changes in liver.? 
What are the diseases in which sympathetic hepatitis occur? 
What is clinical significance of sympathetic hepatitis? 
what are examples ? 
How to differentiate sympathetic hepatitis from true hepatitis? 
Conclusion 
  
  

What is sonographic sympathetic hepatitis? 
Changes occur with in liver when there is inflammation just adjacent to liver & with in draining area of portal vein without direct involvement of liver by bacteria or virus. 

What are the sonographic changes in liver.? 
Changes in the liver are decreased echogenicity diffusely( graded or uniformly), increased echogenicity of portal vein walls upto periphery( usually not seen up to periphery), appearance of echogenic walls for hepatic veins (normally no perceptible walls for hepatic veins sonographically). 

What are the diseases in which sympathetic hepatitis occure? 
  Inflammatory changes adjacent to the liver (Eg: Pyothorax) or in the portal draining area like appendicitis, intra abdominal abscess, infected diverticulae, Perforation of dueodenum or pyosalpinx, Gastro-enteritis, hepatic abscess, pancreatitis, Rt.pyelonephritis,peritinitis etc. 

How to differentiate sympathetic hepatitis from true hepatitis? 
Size of liver is normal & Gall bladder is normal in sympathetic hepatitis. No tenderness over liver. 
Gradient changes are noted Some times in sympathetic hepatitis.Hepatic functional tests are normal. 

Example : 1

   

18y male complaining of pain in the Rt.Iliac fossa, pain, vomiting from last 3days. 
Ultrasound findings : Sub costal view of liver shows decreased echo texture diffusely, portal vein walls are echogenic seen upto periphery, hepatic vein walls are echogenic. Liver is normal in size. Gall bladder is normal. 

Transverse sectional study of appendix shows enlarged appendix with echogenic contents in the lumen. Operation is done. Pus filled appendix is removed. 

 

Example : 2

 

38 Y male complaining of cough and Rt.side chest pain.  Ultrasonography findings :  Subcostal veiw of liver shows decreased echo texture diffusely,  portal vein walls are echogenic seen up to periphery, hepatic walls are echogenic. Liver is normal in size.  On aspiration, straw colour fluid is obtained.  On analysis 1500 lymphocytes  Patient is on ANTI TUBERCULOUS TREATMENT and responding well.  Example : 3

 

32y female complaining of pain lower abdomen , vomiting, fever. 
  
Ultrasonography findings : 
Sub costal view of liver shows decreased echo texture diffusely,  portal vein walls are echogenic  seen up to periphery, hepatic walls are echogenic. Liver is normal in size. Gall bladder is normal. 

On trans vaginal scan Lt.Tube is dilated with internal echoes. 

Example : 4 
   
 
 Example : 5   

          33y male alcohlic patient presented with pain  at rt.hypochondrium. H/O fever 4days back.  

         ULTRASONOGRAPHIC FINDINGS:

         Portal vein walls seen upto periphery 

         Rt.lobe of liver shows hypoechoic SOL which is avascular on CFM. Anchovy saucs like pus aspirated after 5 days

 

 

 

Example 6
 

    10 years female is suffering with typhoid & presented with distended abdomen.

     ULTRASONOGRAPHIC FINDINGS

     Subcoastal viewof liver shows decresed echotextute diffusely & stricking echogenic portal walls upto peripherally.

      HRSG AT RT.IIAC FOSSA & PEVIS shows ascitic fluid with internal echoes.

     Diagnosis is perferation of bowel with peritinitis due to typhoid.