Which storage pattern shows hypoechogenic parenchyma and prominent portal walls, with a 'starry sky' appearance?

Which storage pattern shows hypoechogenic parenchyma and prominent portal walls, with a 'starry sky' appearance?

• A. Excessive
• B. Reduced
• C. Focal Fatty
• D. Normal

Answer: (B)

The liver’s ultrasound appearance reflects how much storage material is present. When storage is reduced, the liver parenchyma becomes relatively hypoechoic, so the background looks darker. The portal walls remain echogenic and stand out against that darker background, producing a bright, dotted network that gives a starry sky look. So the described pattern—hypoechogenic parenchyma with prominent portal walls and a starry sky appearance—fits reduced storage. In contrast, excessive fatty storage would make the liver uniformly brighter and blur the portal structures, and focal fatty changes would show patchy bright areas rather than a uniform starry pattern. Normal would lack these distinctive features.

The liver’s ultrasound appearance reflects how much storage material is present. When storage is reduced, the liver parenchyma becomes relatively hypoechoic, so the background looks darker. The portal walls remain echogenic and stand out against that darker background, producing a bright, dotted network that gives a starry sky look. So the described pattern—hypoechogenic parenchyma with prominent portal walls and a starry sky appearance—fits reduced storage. In contrast, excessive fatty storage would make the liver uniformly brighter and blur the portal structures, and focal fatty changes would show patchy bright areas rather than a uniform starry pattern. Normal would lack these distinctive features.