Acute viral hepatitis (hepatitis A and B, hepatitis C), drug-induced liver injury (acetaminophen), and pancreaticobiliary pathologies leading to biliary obstruction and liver injury are other causes of moderate to marked increase in aminotransferases [34]. CT Abdomen and Pelvis Without IV Contrast Although intra- and extrahepatic biliary ductal dilatation may be identified on CT abdomen and pelvis without IV contrast, contrast confers added benefit for assessment of ischemic liver injury and possible useful hemodynamic information, such as sequela of portal hypertension or hepatic congestion. There are advantages to including the pelvis in the CT abdomen and pelvis examination, including detecting pelvic ascites, pelvic collateral vessels in portal hypertension, and possible sources of obstruction (eg, lymphadenopathy). CT Abdomen and Pelvis With IV Contrast Although the findings of acute hepatitis on CT are not specific for the diagnosis, CT may be useful for evaluating the sequela or complications of hepatitis. CT with IV contrast can also identify ischemic hepatitis. Acute hepatitis on contrast-enhanced CT demonstrates arterial heterogeneity, periportal hypoattenuation, perihepatic lymphadenopathy (>7 mm), and ascites in decreasing order of prevalence [37]. A thickened gallbladder Abnormal Liver Function Tests wall on contrast-enhanced CT (mean 5.2 mm) was an independent predictor of severe hepatitis and prolonged cholestasis [37]. An association of enhanced CT findings with phases of acute hepatitis (prodrome, jaundice, recovery) showed small hepatoduodenal lymphadenopathy, perihepatic fat infiltration, gallbladder wall thickening, contraction, or an undulating inner margin, periportal edema, hepatomegaly, splenomegaly, and pelvic fluid collection in 98.8%, 76.5%, 75.3%, 43.5%, 22.4%, 52.9%, and 56.5% of the patients, respectively [38,39].
Abnormal Liver Function Tests. Acute viral hepatitis (hepatitis A and B, hepatitis C), drug-induced liver injury (acetaminophen), and pancreaticobiliary pathologies leading to biliary obstruction and liver injury are other causes of moderate to marked increase in aminotransferases [34]. CT Abdomen and Pelvis Without IV Contrast Although intra- and extrahepatic biliary ductal dilatation may be identified on CT abdomen and pelvis without IV contrast, contrast confers added benefit for assessment of ischemic liver injury and possible useful hemodynamic information, such as sequela of portal hypertension or hepatic congestion. There are advantages to including the pelvis in the CT abdomen and pelvis examination, including detecting pelvic ascites, pelvic collateral vessels in portal hypertension, and possible sources of obstruction (eg, lymphadenopathy). CT Abdomen and Pelvis With IV Contrast Although the findings of acute hepatitis on CT are not specific for the diagnosis, CT may be useful for evaluating the sequela or complications of hepatitis. CT with IV contrast can also identify ischemic hepatitis. Acute hepatitis on contrast-enhanced CT demonstrates arterial heterogeneity, periportal hypoattenuation, perihepatic lymphadenopathy (>7 mm), and ascites in decreasing order of prevalence [37]. A thickened gallbladder Abnormal Liver Function Tests wall on contrast-enhanced CT (mean 5.2 mm) was an independent predictor of severe hepatitis and prolonged cholestasis [37]. An association of enhanced CT findings with phases of acute hepatitis (prodrome, jaundice, recovery) showed small hepatoduodenal lymphadenopathy, perihepatic fat infiltration, gallbladder wall thickening, contraction, or an undulating inner margin, periportal edema, hepatomegaly, splenomegaly, and pelvic fluid collection in 98.8%, 76.5%, 75.3%, 43.5%, 22.4%, 52.9%, and 56.5% of the patients, respectively [38,39].