Content area
Full text
Abstract
Periportal halos are an uncommon finding on computerised tomography (CT) of the liver. Here, reported a case of periportal halos and hepatomegaly in a patient with eosinophilic gastroenteritis. A 49-year-old male presented with a six week history of right lower quadrant pain and diarrhoea. A CT of the abdomen showed hepatomegaly and multiple hypodense periportal halos around the patent portal veins consistent with periportal oedema. A colonoscopy showed normal looking mucosa in the colon and terminal ileum. Blind biopsies taken throughout the terminal ileum and colon showed increased numbers of eosinophils (more than 25 per high-power field) consistent with eosinophilic gastroenteritis. A liver biopsy showed minimal non-specific chronic inflammatory infiltrates and eosinophils in the portal tracts with ductular proliferation. In conclusion, eosinophilic gastroenteritis should be considered in patients presenting with periportal halos, hepatomegaly, and diarrhoea.
Keywords: periportal, oedema, hepatomegaly, eosinophilic gastroenteritis, diarrhoea, corticosteroid
Introduction
Periportal halos are an uncommon finding on computerised tomography (CT) of the liver. The cause of these halos is probably an accumulation of fluid around the surrounding periportal regions. These periportal halos are typical of periportal oedema and can be seen in patients with trauma, congestive heart failure, pericardial tamponade, venous occlusion after haemotopoietic stem cell transplantation, acute hepatitis, primary sclerosing cholangitis or tumours in the porta hepatis resulting in obstruction of lymphatic drainage (1,2). A case report of periportal halos in a patient with eosinophilic gastroenteritis.
Case Report
A 49-year-old male presented with a six week history of right lower quadrant pain and diarrhoea 10 times a day. He had good past health, was a non-smoker, non-alcoholic, and had not taken any drugs, Western or herbal, in the last six months. Physical examination showed tenderness over the right lower quadrant, but there was no evidence of rebound or rigidity. Liver biochemistry showed elevated serum alanine aminotransaminase 110 U/L (normal range 5-53 U/L), aspartate aminotransaminase 235 U/L (normal range 14-64 U/L), alkaline phosphatase 155 U/L (normal range 30-90 U/L), and gamma glutamyl transpeptidase 180 U/L (normal range < 84 U/L). The patient's albumin, globulin, and bilirubin were normal. A complete blood count, erythrocyte sedimentation rate, C-reactive protein, immunoglobulin E, peripheral eosinophil count, and renal biochemistry were all normal. Hepatitis A, B, C, and E markers were all negative....