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[Acute cholecystitis disclosing A virus hepatitis]
Insights
Hepatitis A virus (HAV) infection in children can mimic acute cholecystitis, presenting with abdominal pain and jaundice. Ultrasonography revealed gallbladder abnormalities, prompting discussion on initial acute cholecystitis.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Diagnostic Imaging
Background:
- Hepatitis A virus (HAV) infection is a common cause of acute viral hepatitis in children.
- Acute cholecystitis is inflammation of the gallbladder, typically presenting with right upper quadrant pain, fever, and jaundice.
- Distinguishing between HAV hepatitis and acute cholecystitis can be challenging clinically and sonographically.
Observation:
- Three pediatric patients with HAV hepatitis presented with symptoms and signs mimicking acute cholecystitis.
- Clinical presentation included right hypochondrium pain, fever, and delayed jaundice.
- Ultrasonographic findings suggestive of acute cholecystitis were observed in all three cases.
Findings:
- Gallbladder wall thickening (>10 mm) was noted in all three patients.
- A layered appearance of the gallbladder wall (2-3 echogenic layers) was present in all three.
- An ultrasonographic Murphy's sign was positive in one patient, and echogenic gallbladder contents were seen in one.
Implications:
- The findings suggest that HAV hepatitis can present with ultrasonographic features indistinguishable from acute cholecystitis in children.
- This highlights the importance of considering viral hepatitis in the differential diagnosis of pediatric acute abdominal conditions.
- Further investigation into the specific sonographic markers differentiating HAV hepatitis from true cholecystitis is warranted.
Abstract:
Three children presenting with HAV hepatitis had an initial clinical onset suggestive of acute cholecystitis (pain and guarding in the right hypochondrium, fever and delayed jaundice) associated with important ultrasonographic abnormalities, also very suggestive of acute cholecystitis: bladder wall thickness greater than 10 mm (3 cases), the presence of 2 or 3 layers of different echogenicities (3 cases), presence of an ultrasonographic Murphy's sign (one case), contents of the gallbladder echogenic (one case). The authors discuss the hypothesis of an actual initial acute cholecystitis.