Status post Paracentesis 7/4/2009 another location
Abdominal ultrasound ordered for abdominal pain and bloating.
Ascites has returned to all four quadrants
Splenomegaly – 14.9 cm - moderate
Liver has irregular contour and is echogenic
Contracted gall bladder contains stones - cholelithiasis
No biliary dilatation seen
Bulky, hypoechoic pancreatic head
Visualized portions of aorta, IVC, and kidneys are within normal limits
CT recommended from US one month later:
Cirrhosis of the liver : shrunken, nodular, nutmeg enhancement, portal hypertension, portal vein hypertrophy
Distal esophageal and gastric varices, umbilical recanalization
Diffuse massive ascites throughout the abdomen
Thickened gall bladder wall and stones noted
Autoimmune Hepatitis – high levels of serum immunoglobulins, specifically IgG, hepatomegaly, splenomegaly, jaundice, signs and symptoms of chronic liver disease. Antimitochondrial antibody may present, antinuclear antibodies and anti-AKLM1 are often positive tests
Hepatitis C – progressive liver fibrosis leading to cirrhosis and end-stage liver disease, hepatocellular carcinoma. HCV has a specific serum titer and has antibody tests
Diagnosis: Hepatitis C
Treatment and follow-up:
Another paracentesis to treat the ascites
Future CT evaluation of the liver: recommendation for both arterial phase as well as delayed phase imaging to better evaluate the liver secondary to the hepatic venous congestion altering liver perfusion.
Current treatment is a combination of Pegylated interferon alpha 2a or Pegylated interferon alpha 2b with the antiviral drug ribavirin for a period of 24 or 48 weeks, depending on hepatitis C virus genotype
Porth C.M., Matfin G., Pathophysiology Concepts of Altered States Eighth edition 2009. Lippincott and Williams pp 962-965 .
Middleton W.D., General and Vascular Ultrasound Case Review Studies Second Edition 2007 pp 175-176
Kawamura D.M., Diagnostic Medical Sonography A Guide to Clinical Practice Abdomen and Superficial Structures Second edition 1997. Lippincott and Williams pp 146-156.