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Ultrasound detection of abdominal lymph nodes in chronic liver diseases. A retrospective analysis
M Soresi1, G Bonfissuto, C Magliarisi
1Cattedra di Medicina Interna, Università di Palermo, via del Vespro 141, 90127, Palermo, Italy.
Insights
Enlarged lymph nodes in the hepato-duodenal ligament are common in chronic liver disease, particularly with hepatitis C virus (HCV) or autoimmune causes. Their presence often indicates more severe liver disease progression.
Area of Science:
- Hepatology
- Radiology
- Gastroenterology
Background:
- Chronic liver disease encompasses various etiologies, including viral hepatitis, autoimmune conditions, and metabolic disorders.
- Hepato-duodenal ligament lymph nodes can be affected in systemic inflammatory processes.
- Ultrasound is a primary imaging modality for evaluating liver disease and associated findings.
Purpose of the Study:
- To determine the prevalence of hepato-duodenal ligament lymph nodes in patients with chronic liver disease.
- To identify clinical, etiological, and laboratory factors associated with the presence of these lymph nodes.
Main Methods:
- Retrospective analysis of 1003 patients with chronic liver disease (chronic hepatitis and cirrhosis).
- Ultrasound examination to detect lymph nodes in the hepato-duodenal ligament region.
- Correlation of lymph node presence with liver disease etiology, viral markers, and disease severity.
Main Results:
- Lymph nodes were detected in 39.3% of patients (394/1003).
- Highest prevalence observed in primary biliary cirrhosis (87.5%), followed by hepatitis C virus (HCV) (42%) and autoimmune hepatitis (40%).
- Lymphadenopathy frequency significantly correlated with worsening liver disease severity (p<0.0001).
Conclusions:
- A high prevalence of lymphadenopathy in the hepato-duodenal ligament exists in chronic liver disease patients.
- Ultrasound detection of these lymph nodes may suggest HCV or autoimmune etiology.
- The presence of lymph nodes is associated with a more severe histological liver disease picture.
Aim:
To retrospectively evaluate the prevalence of lymph nodes of the hepato-duodenal ligament in a group of patients with chronic liver disease of various aetiologies and to investigate what clinical, aetiological and laboratory data may lead to their appearance.
Materials And Methods:
One thousand and three patients (554 men, 449 women) were studied, including 557 with chronic hepatitis and 446 with liver cirrhosis. The presence of lymph nodes near the trunk of the portal vein, hepatic artery, celiac axis, superior mesenteric vein and pancreas head was investigated using ultrasound.
Results:
Lymph nodes were detected in 394 out of the 1003 study patients (39.3%); their number ranged from one to four, with a diameter ranging between 0.8 and 4 cm. The highest prevalence was in the subgroup of patients with primary biliary cirrhosis (87.5%), followed by patients with hepatitis C virus (HCV; 42%), patients with HCV and hepatitis B virus (HBV; 41.3%), autoimmune hepatitis (40%), and HBV alone (21.2%). In the alcoholic and idiopathic subgroups prevalence was 9.5%, while in the non-alcoholic steatohepatitis and haemochromatosis subgroups it was 0%. HCV RNA was present in 97 out of 103 lymph node-positive patients and in 141 out of 168 lymph node-negative HCV-negative patients (p<0.003). Lymphadenopathy frequency increased as the liver disease worsened (chi(2) MH=74.3; p<0.0001).
Conclusion:
Despite the limitations of a retrospective study, our data indicate a high prevalence of lymphadenopathy in liver disease patients; ultrasound evidence of lymph nodes of the hepato-duodenal ligament in a given liver disease may most likely suggest a HCV or an autoimmune aetiology and a more severe histological picture.