Perihepatic lymphAdenopathy in acute Hepatitis [Dietrich CF]

Adequate sonographic visualization of the liver hilus presumed, lymph nodes are detectable within the hepatoduodenal ligament in almost all patients with chronic virus hepatitis C [(1-4)], chronic virus hepatitis B, and autoimmune liver disease, including primary biliary cirrhosis [(5)]. Depending on the stage of the liver disease, enlarged lymph nodes are also found in primary sclerosing cholangitis [(6)], and malignant diseases. It was recently shown that the sonographically determined total perihepatic lymph node volume in patients with chronic hepatitis C is related to liver histology and viremia. Patients with severe histological inflammation showed a larger total perihepatic lymph node volume compared with patients with only mild to moderate inflammatory activity [(2)].

In addition to the patients with chronic liver disease there are only few data in the past on patients with acute hepatitis with confusing results, demonstrating perihepatic lymphadenopathy in only few patients. In a prospective study, we have recently tested the sensitivity of the sonographically sign “perihepatic lymph node enlargement” as parameter of acute viral hepatitis. In our study, lymph nodes within the hepatoduodenal ligament were detected in all 29 patients with acute viral hepatitis and adequate visualization of the liver hilus. However, perihepatic lymph nodes were not enlarged in patients with toxic liver injury and healthy controls. Therefore, the sonographically assessment of perihepatic lymphadenopathy might serve as a highly sensitive diagnostic tool for diagnosing acute viral hepatitis [Braden B, Faust D, Ignee I, Schreiber-Dietrich D, Hirche T, Dietrich CF. Clinical relevance of Perihepatic lymphadenopathy in acute and chronic liver disease. Journal of Clinical Gastroenterology 2008].

Figure 1 (Image Shown)    
Sonographic presentation of enlarged perihepatic lymph nodes ventral and dorsal in the hepatoduodenal ligament (in between markers) in a patient with acute virus hepatitis B.

Reference List

1. Dietrich CF, Zeuzem S. [Sonographic detection of perihepatic lymph nodes: technique and clinical value]. Z Gastroenterol 1999; 37(2):141-151.
2. Dietrich CF, Lee JH, Herrmann G, Teuber G, Roth WK, Caspary WF et al. Enlargement of perihepatic lymph nodes in relation to liver histology and viremia in patients with chronic hepatitis C. Hepatology 1997; 26(2):467-472.
3. Dietrich CF, Stryjek-Kaminska D, Teuber G, Lee JH, Caspary WF, Zeuzem S. Perihepatic lymph nodes as a marker of antiviral response in patients with chronic hepatitis C infection. AJR Am J Roentgenol 2000; 174(3):699-704.
4. Dietrich CF, Viel K, Braden B, Caspary WF, Zeuzem S. [Mediastinal lymphadenopathy: an extrahepatic manifestation of chronic hepatitis C?]. Z Gastroenterol 2000; 38(2):143-152.
5. Dietrich CF, Leuschner MS, Zeuzem S, Herrmann G, Sarrazin C, Caspary WF et al. Peri-hepatic lymphadenopathy in primary biliary cirrhosis reflects progression of the disease. Eur J Gastroenterol Hepatol 1999; 11(7):747-753.
6. Hirche TO, Russler J, Braden B, Schuessler G, Zeuzem S, Wehrmann T et al. Sonographic detection of perihepatic lymphadenopathy is an indicator for primary sclerosing cholangitis in patients with inflammatory bowel disease. Int J Colorectal Dis 2004; 19(6):586-594.