The hyperechogenic liver in children: cause and sonographic appearance.

The clinical records of 28 patients seen in one institution during a recent 2 year period who, on sonography, had been identified as having a hyperechogenic (bright) liver were reviewed. Seven children were diagnosed as having metabolic diseases, four were malnourished, four were receiving hyperalimentation, 10 were receiving chemotherapy, and three were undiagnosed. The sonograms of all the patients and the histologic sections on those who had biopsies, were reevaluated in order to assess the sonographic pattern in greater detail, and these findings were correlated with fatty infiltration and fibrosis of the liver. The bright liver corresponded to the pathologic finding of fatty change. This sonographic finding in children is important, as further evaluation (hepatic biopsy with fat stain, enzymatic analyses, amino acid screens) can be suggested to identify underlying metabolic disorders in those not on therapy. Often the complications of metabolic diseases can be prevented or delayed by early diagnosis and appropriate therapy.