Ultrasound of the liver shows centrilobular or starry sky pattern characterized by increased brightness portal venules and diminished parenchymal echogenicity accentuating the portal venule walls. Acute hepatitis is the most common cause of starry sky appearance. This sonographic appearance is due to the intralobular edematous swelling of the hepatocytes and a change in acoustic properties between the portal venous radicals and hepatic lobules.
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