Get To Know About Echogenic Liver Symptoms

The diffusely echogenic liver is a term that has been used to describe the sonographic appearance of a liver. It appears as if the liver is reflecting back sound waves and as such, it can be seen on an image. This phenomenon is caused by fibrosis of the tissue; it may also be caused by cirrhosis, obesity, or focal nodular hyperplasia. It is difficult to differentiate between the different causes of this condition without performing further diagnostic tests.

Causes of Echogenic liver

Liver fibrosis

This is the most common cause of diffusely echogenic liver. It has been observed that livers that have been damaged by cirrhosis may appear echogenic in the early stages of fibrosis. As fibrosis progresses, it becomes less apparent. This is also a reason why this appearance is not noticed as often among people who are obese.

HCC

In some cases, focal nodular hyperplasia can be seen in patients with cirrhosis, but there is no evidence that this phenomenon occurs due to hepatic cell injury or dysfunction; it appears instead to be caused by damage to the bile ducts by inflammatory cells or fibrosis within the ducts themselves.

ERCP

The procedure of endoscopic retrograde cholangiopancreatography (ERCP) can cause a diffusely echogenic liver because the ultrasound probe is placed against the liver during the procedure. This can cause tearing of the liver and result in mild damage. Over time, this damage may result in fibrosis that causes a diffusely echogenic appearance.

Obesity

In some cases, it has been observed that an obese person is able to have normal liver function (1), but their livers are still subjected to shear forces and, as a result, develop fibrosis. This type of damage is known as “fatty liver.”

Vasculitis

Vasculopathy, which is a condition caused by inflammation in the blood vessels, has also been observed to result in the diffusely echogenic liver. There is no evidence that an infection caused by bacteria or a virus can cause this type of echogenic appearance. The condition often resolves on its own without any treatment or medication. It cannot be differentiated from other causes of the diffusely echogenic liver based on physical examination alone because it causes identical symptoms to other types of fibrosis.

Acute Liver Disease

The echogenic appearance of the liver is a common symptom that indicates that a patient is suffering from acute liver disease, which is caused by an infection or other cause of liver injury. Other symptoms of acute liver disease include fever and jaundice. It can be differentiated from other causes of the diffusely echogenic liver based on physical examination alone because it causes identical symptoms to other types of fibrosis.

Adult Polycystic Kidney Disease

Polycystic kidney disease is a condition in which multiple cysts are formed in the kidneys over time, causing them to become enlarged and damaged. It is known that the kidneys can develop cysts in a number of ways, including from an infection or injury and as a result of certain medications. This condition results in a diffusely echogenic liver because the kidneys are forced to work harder and increase blood flow to them, resulting in the formation of fibrosis.

 

Echogenic liver symptoms

Pain in the abdomen, back, or sides

This is the most common symptom of the diffusely echogenic liver. This is caused by damage to the liver, which causes it to become inflamed. In some cases, this inflammation may extend beyond the liver and cause pain anywhere in the abdomen (in other words, it could not be traced back to its point of origin) or pain that radiates throughout the back and/or sides as a result of fibrosis that has formed between structures. Pain in the sides could result from fatty infiltration of adjacent organs (such as an abdominal wall hernia).

Jaundice

When there is inflammation or damage to the liver, it is often unable to filter toxins from the blood as efficiently as normal. If a patient has diffusely echogenic liver, their jaundice may not be clear in color but rather blue because of the light scattering caused by the fibrosis. This can lead to symptoms such as personality changes, fatigue, and poor appetite.

Hepatomegaly (enlarged liver)

This is an enlargement of the liver that cannot usually be observed on ultrasound but can be seen on CT or MRI scans when other causes of hepatic incidental findings are excluded. The appearance of a liver that has been damaged will become thick, dense tissue with a coarse echo and little detail (especially when the liver is not enlarged). The presence of this symptom in ultrasound can be an indication that there is a diffusely echogenic liver present.

Fatty infiltration

In some cases, fatty infiltration can be present on the scan and may resemble diffusely echogenic liver. It occurs when the hepatic parenchyma becomes filled with fat due to fibrosis around it. This condition is differentiated from the diffusely echogenic liver because it causes identical symptoms to other types of fibrosis. In addition, fatty infiltration rarely occurs in cirrhosis without damage to other organs.

Grading of diffusely echogenic liver

This is a scale used to assess the severity of diffusely echogenic liver. It is based on changes in the ultrasound image that can occur in different structures of the liver. Grading is performed by combining changes in both color and thickness.

 

Mildly echogenic liver

This is the most common form of diffusion of the echogenic liver. It occurs when there are a few scattered echogenic structures that are easily identified on ultrasound. White or gray in color, these structures are not very dense and can change in shape or size with movement. This type of diffusion echogenic liver does not require a biopsy to confirm that there is a diffusely echogenic liver present because it usually resolves on its own without any treatment.

Moderately echogenic liver

This type of diffusely echogenic liver occurs when there is increased density in some of the scan’s focal areas, but the overall appearance remains mild compared to other types of the diffusely echogenic liver. This type of diffusely echogenic liver can be present in many different conditions, but this is not a reliable indicator that there is a diffusely echogenic liver present.

Article Studies, References, and Resources

1. Obesity and Nonalcoholic Fatty Liver Disease: Biochemical, Metabolic and Clinical Implications By Elisa Fabbrini
   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3575093/