[Sonographic detection of perihepatic lymph nodes: technique and clinical value]

Sonographic detection of perihepatic lymphadenopathy by transabdominal ultrasound is helpful in the diagnosis of acute and chronic liver disease but differentiation between benign inflammatory and malignant disease is not possible. The diagnostic value of perihepatic lymphadenopathy has been evaluated in patients with chronic hepatitis C and primary biliary cirrhosis. In patients with chronic hepatitis C enlargement of perihepatic lymph nodes is associated with viremia and is predictive for the presence of severe inflammatory activity with and without cirrhosis. In retrospective studies it could be shown that patients with chronic hepatitis C without response to antiviral therapy do not normalize the size of perihepatic lymph nodes. Future prospective studies have to evaluate whether successful antiviral therapy together with histological improvement will be reflected in an decline of perihepatic lymph node size. In patients with primary biliary cirrhosis the total perihepatic lymph node volume reflect histological stages, i.e. larger lymph nodes are observed in more advanced disease. The mechanism of portal lymphadenopathy in patients with acute and chronic liver disease is unknown. Viral, bacterial infections, and immunological causes are potential etiopathological factors in periportal lympadenopathy. Malignant causes of perihepatic lymphadenopathy have also to be considered.