JPGN reports
September 24, 2026 · via Europe PMC
Ultrasound findings associated with neonatal acute liver failure secondary to gestational alloimmune liver disease: A case series.
Ravanbakhsh N, Upton AM, Huang CS, Galván NTN, Goss J, Harpavat S, Hernandez JA.
AI summary — for doctors, generated from the abstract only
In a retrospective single-centre series of four neonates with acute liver failure from gestational alloimmune liver disease, all four shared the same four ultrasound findings: widely patent ductus venosus, small right portal veins, reversed right portal vein flow and innumerable liver lesions.
What was studied
Retrospective case series from Texas Children's Hospital (2018-2025, IRB H40231) reviewing medical records, imaging and biopsy results of neonates presenting with acute liver failure secondary to gestational alloimmune liver disease. Ultrasound was performed on a GE LOGIQ E10 system, and the aim was to identify sonographic features that could prompt earlier diagnosis.
Key findings
- All four identified patients shared four sonographic findings: a widely patent ductus venosus, small right portal veins, reversal of flow in the right portal vein, and innumerable liver lesions.
- The authors propose that this combination should raise clinical suspicion for gestational alloimmune liver disease and expedite treatment.
- Ultrasound is the first imaging modality used in neonatal acute liver failure but findings are usually described as nonspecific.
Clinical relevance
Gestational alloimmune liver disease is the leading cause of neonatal acute liver failure and is treatable, with some infants needing transplantation despite maximal therapy, so prompt recognition matters. A reproducible sonographic pattern could shorten time to exchange transfusion and immunoglobulin therapy, if validated.
Who should care
Limitations
Only four patients, retrospective, from a single centre, with no comparison group of neonates with acute liver failure from other causes, so the specificity of the four findings is unknown and the apparent 100% concordance is unstable with this sample size. Interpretation is operator-dependent and no blinded re-reading or inter-rater agreement is reported.
A hypothesis-generating sonographic pattern worth looking for in neonatal acute liver failure, but four cases without controls cannot establish diagnostic accuracy.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Objectives
Gestational alloimmune liver disease is the leading cause of neonatal acute liver failure, hypothesized to emerge from maternal exposure to an antigen that is expressed on fetal hepatocytes, resulting in maternal-fetal alloimmune attack and activation of the complement cascade. Despite maximal medical therapy, some require liver transplantation for survival. Prompt recognition is vital. Ultrasound is the first imaging modality utilized in acute liver failure. Results often include nonspecific findings. There is a need for more sonographic findings to facilitate timely diagnosis. We present a case series of neonates who presented with acute liver failure secondary to gestational alloimmune liver disease at Texas Children's Hospital from 2018 to 2025.
Methods
This study was approved by the Baylor College of Medicine International Review Board H40231. Medical records, imaging studies, and biopsy results from 2018 to 2025 were analyzed retrospectively. A General Electric LOGIQ E10 ultrasound machine was used.
Results
All four patients with gestational alloimmune liver disease shared four findings on ultrasound: a widely patent ductus venosus, small right portal veins, reversal of flow in the right portal vein, and innumerable liver lesions.
Conclusion
Our sonographic findings can be used to prompt clinical suspicion for gestational alloimmune liver disease and expedite treatment.
DOI
10.1002/jpr3.70241
PMID
42787442
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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