From the Guidelines
Liver ultrasound is not routinely indicated for uncomplicated Epstein-Barr virus (EBV) infections, but may be considered in cases with significant liver function abnormalities, persistent hepatomegaly, or severe right upper quadrant pain. In most cases of EBV infection, mild hepatitis with transient elevation of liver enzymes is common and self-resolving without specific intervention 1. However, certain situations may warrant a liver ultrasound, such as:
- Significant liver function abnormalities (ALT/AST >5 times normal)
- Persistent hepatomegaly
- Severe right upper quadrant pain
- Signs of complicated disease Ultrasound can help evaluate for complications such as splenic rupture, significant hepatomegaly, or rare cases of EBV-associated lymphoproliferative disorders affecting the liver, as suggested by the need to rule out viral hepatitis and consider radiologic evaluation for biliary obstruction in patients with elevated liver chemistries 1. The decision to perform a liver ultrasound should be individualized based on clinical presentation, with ultrasound reserved for patients with concerning symptoms or laboratory findings suggesting more severe liver involvement. Most EBV-related liver abnormalities resolve spontaneously within 1-2 months as the infection clears, making imaging unnecessary in typical cases where liver enzyme elevations are modest and the patient is improving clinically. According to the AGA clinical practice update, serologic liver investigation to exclude alternative etiologies for liver injury, including viral hepatitis, is recommended 1.
From the Research
Indications for Liver Ultrasound with EBV Infection
There are several indications for liver ultrasound in patients with Epstein-Barr virus (EBV) infection, including:
- Liver injury or hepatitis, which can be caused by EBV infection 2, 3, 4, 5
- Elevated liver transaminases, which can indicate liver damage 2, 3, 5
- Jaundice, which can be a symptom of liver disease 2, 3, 5
- Cholestatic hepatitis, which can be caused by EBV infection 2, 3, 5
- Autoimmune liver disease, which can be associated with EBV infection 2, 6
- Liver failure, which can be a complication of severe EBV infection 2, 4, 5
Clinical Features of EBV Infection
The clinical features of EBV infection that may indicate the need for a liver ultrasound include:
- Infectious mononucleosis syndrome 2, 3
- Acute hepatitis with mild to moderate elevation of liver transaminases 2, 3, 5
- Cholestatic hepatitis with elevated alkaline phosphatase and γ-glutamyltransferase 2, 3, 5
- Jaundice, which can be a symptom of liver disease 2, 3, 5
Diagnostic Considerations
When considering a liver ultrasound for a patient with EBV infection, it is essential to correlate clinical history, laboratory findings, and histopathologic features to distinguish EBV hepatitis from other conditions, such as: