A case of hepatic sarcoidosis: What can ultrasound, colour, power, and pulsed Doppler do?

Liver involvement is a rare ongoing occurrence of systemic sarcoidosis, and it can be difficult to recognise.

A case of how imaging was used to diagnose hepatic sarcoidosis in a 45-year-old male with clinical and biochemical signs of hepatic liver disease is reported.

Hepatic sarcoidosis may initially present with abnormality in liver function. The presence of multiple focal liver lesions may be seen on B-mode ultrasound imaging, suggesting a differential diagnosis of inflammatory, infectious, immunological, or neoplastic pathologies with potential hepatic involvement. In this case, ultrasound imaging, with colour Doppler, was the first tool with which to decide the next steps. The use of colour and pulsed Doppler demonstrated signs of compression of the hepatic microcirculation by liver nodules, compatible with a systemic pathology such as hepatic sarcoidosis. The definitive diagnosis was then reached via liver biopsy.

Superb microvascular imaging, colour-power Doppler, and pulsed Doppler are important adjuncts to B-mode ultrasound imaging of the liver, which allow identification of hepatic microvascular circulation compression necessary to inform a timely diagnosis of hepatic sarcoidosis and inform treatment.