Perihepatic lymphadenopathy indicates aetiology of acute and chronic liver disease
Aim: In chronic virus hepatitis C the total perihepatic lymph node volume reflects liver histology, viremia, and the immunological response. Therefore, it is helpful in the diagnostic work-up. This study prospectively assessed whether perihepatic lymphadenopathy indicates the aetiology of acute (and chronic) hepatitis which is essential for further management.
Methods: In 40 consecutive patients with transaminases higher than 500 U/L without known liver disease the total perihepatic lymph node volume was assessed and compared to the ultrasound findings in 263 patients with chronic liver diseases and 49 healthy controls.
Results: In 31 patients an acute viral hepatitis, in 9 patients toxic causes had resulted in acute liver damage. In all sonographically evaluable patients with acute viral hepatitis (29/31, 94%) perihepatic lymphadenopathy was found, whereas none of the patients with toxic causes revealed lymphadenopathy. In chronic liver disease, perihepatic lymphadenopathy was present in 86% of viral, in 90% of autoimmune hepatitis, in 100% of primary sclerosing cholangitis, in 97% of primary biliary cirrhosis, but only in 6% of hemochromatosis, in 1% of fatty liver disease, and in 4% of cholecystolithiasis.
Conclusions: Perihepatic lymphadenopathy is found in infectious and autoimmune liver diseases, but not in metabolic or toxic liver damage. The absence of perihepatic lymph nodes in acute liver failure should lead to intensive search for toxic agents.