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What Causes Diffuse Echogenicity In Liver With Raised ALT Levels?

Posted on Tue, 20 Oct 2015

Question: My great granddaughter had a US of the abdomen that showed heterogeneous echogenicity of the liver. A follow up abd xray revealed only a dilated bowel loop. Her lab work was all within normal limits except for an elevated ALT which was 91. What does all this mean?
She is 3 months old.

Answered by Dr. Pradeep Kumar Jain (48 minutes later)

Brief Answer:
Lab finding needs to be clinically correlated

Detailed Answer:
Hello

Thanks for asking on this platform

There can be so many causes of diffuse echogenicity in liver with raised ALT.
ALT is a liver enzyme which gets increased in liver cell injury.Value of ALT considered to be significant when it is raised 4 times above the normal limit (about 32-35).
Neonatal hepatitis is a condition which can cause both the heterogenous echogenicity and raised ALT.
I would like to know the condition for which the physician has advised the USG.
Dilated bowel loop in X ray is a very nonspecific finding and is not significant if there is no abdominal distension,no vomiting and baby is passing stool normally.

So please let me know the clinical condition also so that I better able to correlate this and help you out.

Regards

Above answer was peer-reviewed by : Dr. Neel Kudchadkar

Follow up: Dr. Pradeep Kumar Jain (2 hours later)

The baby originally went to see her pediatrician for a rt check up at 4 wks and her mother questioned the Dr regarding what we assumed was colic and a hard swollen belly. The Dr thought it was within the normal limits and detected no masses or pain when she examined the abd. When she returned for her rt check about 2 weeks ago, Dr decided that the abd looked more distended and she ordered the Ultrasound.The baby is frequently troubled by what we assume to be gas and sometimes spits up. She also did not gain as much weight this time as was expected and she had not grown as much as was expected. It was also said that the circumference of her skull had not changed as expected. I think this might depend on how and who is doing the measurements, but I don't know that for sure. Other than seeming to suffer from gas pains ( drawing her legs up and crying ) periodically, she is
a very happy, sweet little baby.
With this further information, can you be more specific about what might be going on with this baby?

Answered by Dr. Pradeep Kumar Jain (3 hours later)

Brief Answer:
I don't think that USG and Xray report is significant

Detailed Answer:
Thanks for follow up

Gone through the details.
Mild intermittent distension of abdomen and spitting is very common in early age.
In absence of jaundice or any other significant complaint,when apart from USG,xray and ALT all other reports are normal;I don't think these reports have something to do with the baby's growth.

You are right.The head circumference should be taken very cautiously and many a times it is only technical error which makes the parents anxious.
I would like to know the birth weight and present weight of the baby as growth monitoring by serial weight record is easier.Also if head circumference is static (less than 35 cm)it indicates poor head growth.
I wont get overly worried if baby is gaining weight,head circumference has increased by at least 4 cm since birth,is developmentally normal, passing stool well and vomiting is not persistent .

I would suggest you to consult your pediatrician for proper growth assessment.

I shall be glad to help if you have any more doubt.
Regards

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Above answer was peer-reviewed by : Dr. Sonia Raina