Starry sky liver us

Periportal tract brightness (also known as periportal echogenicity or periportal cuffing) is a sonographic finding seen on abdominal ultrasound, particularly around the portal triads in the liver.

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What It Looks Like on Ultrasound:

• Increased echogenicity (brightness) along the portal vein branches.
• Appears as linear bright streaks radiating from the portal vein into the liver parenchyma.

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Possible Causes of Periportal Tract Brightness:

Cause	Mechanism
Hepatitis (viral or toxic)	Inflammatory edema or infiltration
Congestive heart failure	Hepatic venous congestion
Lymphatic congestion	Interstitial edema along portal triads
Cholestasis / Obstructive jaundice	Bile duct dilatation and periportal edema
Liver transplant (post-op)	Common post-transplant finding (fluid, inflammation)
Cirrhosis / Fibrosis	Sometimes seen in early stages
Neonates	Can be normal in newborns due to immature liver architecture

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Clinical Context Is Essential:

Periportal brightness is non-specific — it’s a sign, not a diagnosis. It must be interpreted in light of:

• Liver function tests
• Signs of infection or heart failure
• Clinical symptoms (e.g., jaundice, ascites)

Let me know if you’d like help correlating this with lab results or a specific patient case.

A

The “starry sky” appearance of the liver on ultrasound (US) refers to a distinctive pattern where:

• The liver parenchyma appears hypoechoic (darker),
• While the portal venous walls and hepatic structures (which remain echogenic or bright) stand out like “stars” against the “sky” of the darkened liver background.

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Mechanism:

This appearance results from:

• Edema or inflammation of the liver → hypoechoic background
• Normal or prominent echogenicity of portal vein walls → bright dots/streaks

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Common Causes of Starry Sky Liver:

Condition	Mechanism
Acute hepatitis	Hepatocellular edema
Viral hepatitis (especially in children)	Common classic cause
Lymphoma (especially in children)	Infiltrative disease
Congestive hepatopathy	Passive venous congestion
Sepsis / shock liver	Hepatic ischemia or inflammation
Normal finding in children	Due to less fatty infiltration and prominent vasculature

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In Pediatrics:

• A starry sky liver is often seen in children with viral hepatitis, such as hepatitis A or E.
• May also be a transient normal variant in neonates.

✅ Summary:

The “starry sky” liver on ultrasound is a non-specific but important indicator of acute liver inflammation, most classically due to acute viral hepatitis, but also seen in sepsis, lymphoma, and congestive liver.

Would you like a visual example or comparison with CT/MRI findings?