Reports on cholecystic alterations during acute viral hepatitis are more and more frequent; the pathogenesis and clinical meaning of these alterations are still debated. Consensual periportal lymphnode enlargement has been not yet reported. The authors describe four cases of acute viral hepatitis in which US showed alterations of cholecystic walls and/or contents; in two cases enlarged periportal lymphnodes were demonstrated too. Later US exams showed a complete regression of both cholecystic and lymphnodal lesions. Clinical findings and laboratory out-comes are evaluated; the connection of US results with hepatitis and its meaning are discussed. The causes of cholecystic alterations are still questionable; they might be related to blood disorders or to an increased portal pressure, or else they might be considered as phlogistic lesions. The authors conclude that both cholecystic and lymphnodal alterations have a phlogistic nature; moreover, they are not related to a particular evolution of hepatitis. The importance of distinguishing cholecystic alterations from different pathologies is stressed.