Hepatic and biliary tract abnormalities in patients with AIDS. Sonographic-pathologic correlation.

A retrospective evaluation of hepatobiliary sonograms in 22 patients with AIDS was performed and the sonographic abnormalities were correlated with pathologic findings in 10 patients. Hepatic parenchymal abnormalities noted on ultrasound include a hyperechoic parenchymal echo pattern in 45.5%, hepatomegaly in 41%, and focal masses in 9% of patients. Etiologies for the diffuse hyperechoic pattern based on pathologic correlation in eight cases were hepatic steatosis and granulomatous hepatitis. Biliary tract abnormalities identified included gallbladder wall thickening in 55% of patients, dilated gallbladder in 18%, biliary sludge in 23%, and gallstones in 5% of patients. Extrahepatic ductal dilation was seen in 23% of patients, but the intrahepatic ducts were dilated in only 5% of patients. Possible etiologies for biliary tract abnormalities suggested by pathologic correlation in five patients and literature review were cytomegalovirus and cryptosporidial infection, although constitutional factors may have played a role. Hepatobiliary ultrasound is, therefore, an effective screening tool for directing further diagnostic and therapeutic procedures in AIDS patients presenting with clinical evidence of hepatobiliary dysfunction.