Clinical relevance of perihepatic lymphadenopathy in acute and chronic liver disease.

BACKGROUND AND GOAL: In chronic virus hepatitis C the total perihepatic lymph node volume reflects the underlying liver histology, viral load, and the host's immunologic response. Assessment of the perihepatic lymph node volume may represent an important diagnostic tool, and may help streamline the patient's further management. The purpose of this study was to prospectively assess whether perihepatic lymphadenopathy is associated with the etiology of acute (and chronic) hepatitis.

STUDY: In 40 consecutive patients with transaminases >500 U/L without known liver disease the total perihepatic lymph node volume was assessed and compared with the ultrasound findings in 263 patients with known chronic liver disease and also 49 healthy controls.

RESULTS

Thirty-one out of 40 patients were diagnosed with an acute viral hepatitis, whereas 9/40 patients were diagnosed with a toxic cause, resulting in acute liver damage. In all sonographically evaluated patients with acute viral hepatitis (29/31, 94%) perihepatic lymphadenopathy was found, whereas none of the patients with a toxic cause demonstrated 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 a toxic or metabolic cause.