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  • Periportal edema

    Posted by Ajackcash on March 1, 2023 at 11:15 am

    I frequently run into mild periportal edema and pericholecystic fluid in young seemingly healthy patients. Feel like its likely often not clinically relevant but google just says trauma, heart failure, liver disease etc. Anyone else have similar experience? I throw in aggressive IV hydration in the ddx to try and offer a benign etiology

    radiologydiagnose replied 1 year, 4 months ago 14 Members · 15 Replies
  • 15 Replies
  • emily.perry_477

    Member
    March 1, 2023 at 11:25 am

    What modality do you see them on ?
     

    • mario.mtz30_447

      Member
      March 1, 2023 at 1:09 pm

      CT

      • mircea.cg_544

        Member
        March 1, 2023 at 1:42 pm

        I see it from ER with the great history of nonspecific abdominal pain.

        My Impression mild nonspecific periportal edema

        No negative feedback so far x years

        • hugolpneves_898

          Member
          March 1, 2023 at 3:59 pm

          Cholangitis or hepatitis. Harder in someone who really doesnt have deferrable symptoms.

          • shahinahshilpi

            Member
            March 1, 2023 at 4:24 pm

            Nonspecific but sometimes associated with hepatitis

            If it seems likely by history

            • Ajackcash

              Member
              March 1, 2023 at 4:32 pm

              Yeah CT. Ok sounds like theres been no revelation since I finished residency way back when. The history is always abdominal pain. Lol. Thanks all.

        • rileytnt

          Member
          March 1, 2023 at 4:38 pm

          It can be from hepatic congestion, particularly if the right heart, IVC and hepatic veins are big. Vigorous IV hydration is basically the same mechanism. If there is diffuse GB thickening, I says the pattern can be seen with hepatitis.

          • Unknown Member

            Deleted User
            March 1, 2023 at 6:11 pm

            ^^^^^^
            overhydration is the most common etiology in my experience. Pretty common in the Ed.  

            • william.wang_997

              Member
              March 1, 2023 at 8:49 pm

              I agree. In a young person coming into it is most likely related to overhydration. I have mentioned it and said nonspecific.

              • vhudson_121

                Member
                March 1, 2023 at 10:59 pm

                Increased blood volume- if ivc/and hepatic veins distended 

                • maria.labouyer_887

                  Member
                  March 2, 2023 at 2:40 pm

                  Most commonly due to IV fluids. I was told by ED physician that almost every patient gets a bolus. To confirm, look for IVC distension.

                  • Melenas

                    Member
                    March 2, 2023 at 4:48 pm

                    How often to you use non specific in your reports daily? On the other side, do you ever say this is a specific finding for X? 

                    • tom.claikens_334

                      Member
                      March 2, 2023 at 9:28 pm

                      .

                    • Ajackcash

                      Member
                      March 3, 2023 at 8:50 am

                      Good discussion. Ill take a closer look at the IVC when I see this in the young ER pts that look otherwise pretty healthy without evidence of portal hypertension, chronic liver disease, and CHF/systemic congestion. I feel like acute hepatitis is not all that common relative to the frequency of this finding. Can just call mild periportal, nonspecific, likely related to IV hydration. Not point in calling it over hydrationjust will slightly increase chance of angering/getting a call from some ordering doc. I say nonspecific pretty often lol. Mild pelvic free fluid etc. There are times when I give a solid diagnosislike fractures, appendicitis, hepatic cysts, just to name a few!

                    • radiologydiagnose

                      Member
                      March 3, 2023 at 9:33 am

                      Here is my macro for this: Differential diagnosis includes aggressive fluid resuscitation, acute hepatitis, or secondary cardiac congestion. Other intra-abdominal inflammatory processes can also sometimes cause this appearance.