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Media Gallery

Conjugated Hyperbilirubinemia. This gross liver specimen from a patient with Dubin-Johnson syndrome shows multiple areas of dark pigmentation. Image courtesy of Cirilo Sotelo-Avila, MD.
Conjugated Hyperbilirubinemia. The microscopic histologic image of the liver in Dubin-Johnson syndrome shows multiple areas of granulated pigment. Fontana Mason stain. Image courtesy of Cirilo Sotelo-Avila, MD.
Conjugated Hyperbilirubinemia. This liver biopsy specimen demonstrates the ground-glass appearance of hepatocytes in a patient with hepatitis B.
Conjugated Hyperbilirubinemia. A plain abdominal radiograph in a patient with a clinical diagnosis of acute cholecystitis is shown. The diagnosis was confirmed by means of abdominal ultrasonography. The radiograph shows faint opacities in the region of the gallbladder fossa (red circle) and dilated loops of small bowel in the epigastrium and midabdomen secondary to localized ileus.
Conjugated Hyperbilirubinemia. A 26-year-old man known to be positive for human immunodeficiency virus (HIV) presented with pain in the right upper quadrant and mild jaundice. This axial sonogram through the gallbladder (GB) and pancreas (P) shows sludge within the gallbladder and the lower common bile duct (arrow). A diagnosis of acalculous cholecystitis was confirmed. A = aorta; IVC = inferior vena cava; S = splenic vein.

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Table. Differential Diagnosis of Conjugated Hyperbilirubinemia

Table. Differential Diagnosis of Conjugated Hyperbilirubinemia

I. Acute or Chronic Hepatocellular Dysfunction	II. Diseases That Prevent Flow of Bile Into the Intestine
A. Infection	A. Damage to Intrahepatic Bile Ducts or Portal Tracts
Viral hepatitis A-E Cytomegalovirus (CMV) hepatitis Epstein-Barr virus (EBV) hepatitis Sepsis	Primary biliary cholangitis Graft versus host disease Veno-occlusive disease Sclerosing cholangitis
B. Inflammation Without Infection	B. Damage to or Obstruction of Larger Bile Ducts
Toxic liver injury Drug toxicity (eg, acetaminophen) Halothane hepatitis Alcoholic hepatitis Iron overload (hemochromatosis) Copper overload (Wilson disease) Autoimmune hepatitis	Choledocholithiasis Sclerosing cholangitis Acquired immunodeficiency syndrome (AIDS) cholangiopathy Hepatic arterial chemotherapy Postsurgical strictures Bile duct cancers Developmental disorders of the bile ducts (eg, Caroli disease) Extrinsic compression of the bile duct Tumors Acute pancreatitis
C. Metabolic Dysfunction	C. Diffuse Infiltrative Diseases
Ischemia ("shock liver") Acute fatty liver of pregnancy Alpha-1 antitrypsin deficiency Preeclampsia Reye syndrome Total parenteral nutrition	Granulomatous diseases Sarcoidosis Disseminated mycobacterial infections Lymphoma Wegener granulomatosis Amyloidosis Diffuse malignancy
D. Inborn Errors of Metabolism	D. Diseases That Interfere With Biliary Secretion of Bilirubin
Dubin-Johnson syndrome Rotor syndrome Benign recurrent cholestasis	Drug-induced cholestasis, as with the following: Chlorpromazine Erythromycin Estrogens Anabolic steroids Many others

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