Ultrasonography of the Liver in AIDS Patients among Sudanese Population


  • Ala Mohammed
  • Hamid Osman
  • Amin Elzaki
  • E. Abd Elrahim


Radiologic Technology


The National Ribat University,Faculty of Radiological and Nuclear Medicine Science
Taif University, College of Applied Medical Science
Faculty of Radiology Science and Medical Imaging, Alzaiem Alazhari University


The first reports of homosexual patients suffering from previously rare diseases such as pneumocystis pneumonia and Kaposi's sarcoma were published in May 1981. It soon became clear that the new disease affected other population groups as well, when the first cases were reported in injecting drug users. However, it took almost two years until, in 1983, the human immunodeficiency virus was defined as the primary cause of the acquired immunodeficiency syndrome, now HIV infection has changed from a fatal condition to a manageable chronic illness. [1]

HIV/AIDS has now reached epidemic proportion in all Sub-Saharan African countries endangering not just the lives of its victims but also the social and economic fabric of society. Most health institutions in the sub region including Sudan are not adequately equipped to properly evaluate the HIV/AIDS patient and the complications that often arise from the condition. Its infectious and noninfectious complications can be overwhelming and may be impossible to diagnose accurately in developing countries because of lack of diagnostic facilities [6-7].

Areas affected by AIDS include central nervous system (limitation of ultrasound imposed by bones), respiratory system (ultrasound imposed by air in lung), abdominal retroperitoneal and superficial. Sonographic findings are prevalent non-specific abdominal abnormalities associated with AIDS include splenomegaly, hepatomegaly, hyperechoic liver parenchyma, gallbladder wall thicking, Lymphadenopathy and nephropathy [2].

Hepatic pathology associated with AIDS includes Cardiac dysfunction, which is common in patient with AIDS particularly IV drug abusers (abdominal Sonographic findings indicative of cardiogenic congestion include hepatomegaly and dilation of hepatic vein and (IVC), non-Hodgkin's lymphoma (25% have focal lesion), hepatocellular carcinoma HCC, Kaposi's sarcoma (small hyperechoic nodules and preportal thicking) and liver micro abscesses (usually <1cm most common fungal infection) [2].


Summary of Work

The main objective of this study was to evaluate the liver parenchyma echogenicity in AIDS patients, and performed as a Prospective evaluation of known AIDS patients using abdominal ultrasonography of 50 patients concerning on liver's Echogenicity, liver parenchymal texture. The effect of age, gender, abnormality findings and onset was statistically analyzed. Out 50 cases with known AIDS, 22 (44%) were females; their age was ranged between (41–50 years). The disease was most prevalent in the 4th decade with an incidence of 36%. AIDS patients were found to have a high prevalence of underlying hepatic abnormalities. The results suggest that hepatic tuberculosis is more common in AIDS than previously recognized more studies are recommended on portal hypertension

Summary of Results

Of the 50 cases, 22 (44%) were females; their age was ranged between (41–50 years). The disease was most prevalent in the 4th decade with an incidence of 36%. Table 1: Age group distribution in HIV+ Patients

The table findings matched with comparable study by Tshibwabwa et al in a similar environment [6]. Their study showed a higher male prevalence. (Figure 1).

The report of hepatic findings in this study is noticed for the frequency of portal hypertension (26%) (Figure 2) which is differ from [4] study performed by Langer et al., 1993 they didn't find any case of portal hypertension in their study and also differ from [5] study done by Lanjewar et al, 2004.

In this study fatty liver (bright liver), were 8/30 (16%) patients which matches the study of Langer et al., 1993 [8] and but it differ from the study of Lanjewar et al, 2004 [5] they didn't report any case of fatty liver, Lymphadenopathy as demonstrated on abdominal ultrasound was a relatively infrequent finding only seen in two patients (4%) which is agree with study performed by Langer et al., 1993 [8] they reported it in their study. In 16% (8/30 patents) an enlarged liver were diagnosed, in 10% (5 patients) an enlarged spleen were diagnosed and this matches with Langer et al., 1993[8] they reported hepatospleenomegaly in their study, but it disagrees with previous reports [3,5,8,9]. Yee et al [10] and Geoffray et al [11], identified splenomegaly in 45% and 32.5% of their patients respectively as high incidence.


The Conclusions of this study was AIDS patients were found to have a high prevalence of underlying hepatic abnormalities.

Take-home Messages

[1] Bernd Sebastian Kamps and Christian Hoffmann, 2007, HIV Medicine 2007, Flying publisher, viewed 10th March 2007 URL: http://www.hivmedicine.com/textbook/intro.htm.

[2] Dr. Syed Amir Gilany (2002): Guidelines and Protocols for Medical Diagnostic Ultrasound, 1st edition, The Burwin Institute of ultrasound, Lahour: Pakistan

[3] Herald T. Lutz &Hassen A. Gharbi., 2006, Manual of diagnostic ultrasound in infectious tropical diseases , springer-verlag; Berlin Heidelberg, Germany.

[4] Langer R, Langer M, Schütze B, Wakat JP, Zwicker C, Felix R., 1988 June, ” Ultrasound findings in patients with AIDS”, US National Library of Medicine, National Institutes of Health,, 8(2):93-6, viewed on June 14th 2006.

[5] DN Lanjewar, RJ Rao, SB Kulkarni and SK Hira, 2004, " Hepatic pathology in AIDS: a pathological study from Mumbai, India" British HIV Association, HIV Medicine (2004), 5, 253– 257 Viewd Dec,2005,

[6] URL:http://onlinelibrary.wiley.com/doi/10.1111/j.1468-1293. 2004.00217.x/pdf

[7] Tshibwabwa ET, Mwaba P, Bogle-Taylor J, Zumla A: Four-year study of abdominal ultrasound in 900 Central African adults with AIDS referred for diagnostic imaging. Abdmen Imaging 2000, 25:290-296. PubMed Abstract | Publisher Full Text

[8] Smith FJ, Matheson JR, Cooperberg PL: Abdominal abnormalities in AIDS: detection at ultrasound in a large population. Radiology 1994, 192:691-695. PubMed Abstract | Publisher Full Text.

[9] Langer R, Langer M, Schutze B, Zwicker C, Wakat JP, Felix R: Abdominal Sonographic findings in patients with AIDS. Rontgenblatter 1989, 42:121-125. PubMed Abstract

[10] N'Zi PK, Coulibaly A, N'Dri K, Quattara ND, Diabate SA, Zunon-kipre E, Djedje AT:Ultrasound aspects of abdominal involvement in adults with HIV infections in the Ivory Coast: apropos of 146 cases. Sante 1999, 9:85-88. PubMed Abstract | Publisher Full Text

[11] Yee JM, Raghavendra BN, Horii SC, Ambrosino M: Abdominal Sonography in AIDS: A Review. J Ultrasound Med 1989, 8:705- 714. PubMed Abstract

[12] Geoffray A, Binet A, Cassuto JP, Dujardin P, Coussement A: Sonography of abdominal adenopathies in patients with antiHIV-positive serology. In Imaging of AIDS. Edited by Troto P. Philadelphia, Pa: Decker; 1991::189-194. 

Summary of Work
Summary of Results
Take-home Messages

The results suggest that portal hypertension is more common in AIDS than previously recognized. More researches and studies should be done on this topic.

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