SONOGRAPHIC DETECTION OF FOCAL CHANGES IN THE LIVER HILUS IN PATIENTSRECEIVING CORTICOSTEROID-THERAPY

Objective: While diffuse deposition of fat may occur with corticostero id (CS) administration both in the liver and in other organs, comparat ively little is known about focal changes in the liver under corticost eroid medication. Therefore, we evaluated pattern and extent of focal hepatic steatosis by ultrasound (US) in patients receiving corticoster oids. Subjects and methods: 93 patients with known inflammatory bowel disease (IBD) received corticosteroids during a period of at least six weeks prior to the ultrasound examination and 28 IBD-patients had no corticosteroids within the last three years. 13 additional patients re ceived corticosteroids for other reasons than IBD for > 1 year. 80 hea lthy volunteers served as controls. Focal changes of the liver as asse ssed by high resolution ultrasound (Acuson 128, 3.5 and 5 MHz) were de fined as areas of brighter echogenicity compared to the general aspect of the liver. The size of the hyperechoic areas was documented (photo print). Results: 40/93 IBD-patients with corticosteroids (43%) had def inite areas of brighter echos in the hilus region of the liver. In IBD -patients without corticosteroids only one patient showed a focal brig hter areas (5%). Conclusion: Bright focal areas in the liver hilus occ ur in > 40% of IBD-patients during corticosteroid medication. This phe nomenon occurs in IBD-patients as frequently and as intense as in othe r patients with longstanding corticosteroid therapy. There is a hilar area of the liver with typical size and location which reacts to corti costeroid administration with hyperechoic reflexes at ultrasound inves tigation. This is important to know when it comes to the differential diagnosis of focal changes.