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Hepatic Infarction

Infarct of Liver

Hepatic infarction (HI) is necrosis of a segment of liver cells due to ischemia caused mainly by vaso-occlusion. The liver receives a rich blood supply and so, HI is a rare condition.


Presentation

The liver has a dual blood supply, involving the hepatic artery and the portal vein. In addition to that, it has a well-developed collateral system, thus hepatic infarction (HI) is not a frequent ailment [1]. HI occurs when both aforementioned major blood vessels are compromised, leading to ischemia of the liver parenchyma. This, in turn, leads to coagulative necrosis of hepatic tissue. Portal vein thrombosis is often the precipitating factor in HI. There are various causes of HI, including iatrogenic, infective, vascular, post-traumatic and coagulopathic events.

Examples of specific conditions that predispose to HI include those that compromise blood flow to the liver, that is, hypercoagulable states, portal vein thrombosis, hepatic artery occlusion and atherosclerosis. Further, the situations that increase an individual's susceptibility to HI include diabetes, hypovolemia and shock, sepsis and biliary tree disease. Recorded iatrogenic factors include surgical interventions, both open and laparoscopic, liver transplant, and vascular procedures such as trans-catheter arterial embolization and intra-arterial chemoinfusion [1]. Other elements that increase the risk of HI entail vasoconstrictors that act centrally (thus affecting the blood supply of abdominal organs), atherosclerosis and pancreatitis [2] [3] [4].

Patients with HI may be asymptomatic [5]. In the symptomatic individuals, onset is sudden, and common complaints are right upper quadrant pain, fever, jaundice and gastrointestinal upset [6]. Diabetics may not report any pain, due to neuropathy related to hyperglycemia. The white cell count, aspartate transaminase (AST) and alanine transaminase (ALT) are often raised. This medical entity is common in people who underwent a liver transplant.

Aspiration
  • The infarctions were documented by computed tomographic scan and needle aspiration biopsy of the liver. Except for the nephrotic syndrome and the atherosclerosis no other cause of hepatic infarction was found.[ncbi.nlm.nih.gov]
Right Flank Pain
  • Two months later, she experienced right hypochondralgia and right flank pain. Serum transaminase levels were suddenly elevated, and computed tomography scans of the liver showed multiple small nodular lesions.[ncbi.nlm.nih.gov]
Severe Abdominal Pain
  • We present a patient who in the third trimester of pregnancy developed severe abdominal pain, fever and transaminases greater than 30 times normal.[ncbi.nlm.nih.gov]

Workup

Hepatic infarction is best diagnosed via abdominal computerized tomography (CT) scans. Both contrast and non-contrast CTs are used. Non-contrast CT shows an HI as a wedge shaped area of low attenuation. Contrasted CT may highlight impaired perfusion in the infarcted tissue [7]. The site, extent and possible underlying pathology of the HI can be assessed using a CT scan [8]. Abdominal ultrasound examination may reveal hypoechoic lesions and calcifications that suggest infarction. Complications of HI, particularly those of the biliary tree, include abnormal collections of bile, and biliary strictures [9].

Physical examination is important. Positive findings could include jaundice, which may indicate liver failure [6].

Biochemical studies may show elevated aminotransaminase, whereas increased levels of serum bilirubin as well as abnormalities in clotting studies, exemplified by prolonged prothrombin time (PT) and international normalized ratio (INR), are possible findings [5] [6]. Ultrasound scanning and angiography are both useful in locating blockage of a vessel. Nuclear imaging helps in visualizing the areas of necrosis.

Different types of angiography can be used, including CT and magnetic resonance (MR).

Treatment

  • We believe that liver cirrhosis and chronic pancreatitis were the main risk factors for the portal thrombosis, and the treatment for esophageal varices appeared to have triggered the thrombosis.[ncbi.nlm.nih.gov]
  • She was discharged five weeks postpartum with no additional treatment, and is without sequelae six months later.[ncbi.nlm.nih.gov]
  • Magnetic resonance imaging was the imaging modality of choice for diagnosing hepatic infarction, guiding treatment, ensuring the early detection of bleeding, and monitoring liver recovery.[ncbi.nlm.nih.gov]
  • The authors describe a patient who had a secondary liver infarct during anticoagulant treatment for cerebral infarction.[ncbi.nlm.nih.gov]
  • The only effective treatment for these patients is intensive supportive care and urgent liver transplantation.[ncbi.nlm.nih.gov]

Prognosis

  • The authors evaluated the frequency of hepatic infarction, clinical features, initial and follow-up CT findings, accompanied complications, and prognosis. Potential risk factors were evaluated with multiple logistic regression analysis.[ncbi.nlm.nih.gov]
  • Prognosis The prognosis is mostly related to the severity of the underlying systemic disease. Causes Hepatic artery damage due to.....[gastroenterologybook.com]
  • Classification and staging are discussed at length with reference to treatment planning and correlation to prognosis. Diagnostic tools including X-Ray, CT scan, MRI and bone scan are also described in detail.[books.google.ro]
  • Ischemic hepatitis is generally benign and self-limited, and prognosis is more related to the underlying etiology of shock.[errolozdalga.com]

Etiology

  • The etiology, clinical course, and radiologic features of liver infarction are summarized, and the importance of recognizing and treating this form of hypercoagulability is stressed.[ncbi.nlm.nih.gov]
  • Etiologies of infarction included posttransplant complication (15), laparoscopic cholecystectomy complication (2), and traumatic arterial injury (1).[ncbi.nlm.nih.gov]
  • The identification of bleeding foci, as well as the etiology of varices, can be challengi...[medworm.com]
  • Ischemic hepatitis is generally benign and self-limited, and prognosis is more related to the underlying etiology of shock.[errolozdalga.com]
  • Citation: Endocrinology, Diabetes & Metabolism Case Reports 2017, 1; 10.1530/EDM-16-0144 Discussion The etiology of mesenteric ischemia represents a complex of diseases, including acute arterial mesenteric ischemia, acute venous mesenteric ischemia, non-occlusive[edmcasereports.com]

Epidemiology

  • […] mutated hepatocellular adenoma (HA-B, 10%) Inflammatory hepatocellular adenoma (HA-I, 35%) Sonic hedgehog ( SHH ) hepatocellular adenoma (HA-sh, 5%) Hepatocellular adenoma, not otherwise specified (HA-U, 7%) ICD coding D13.4 : Benign neoplasm of liver Epidemiology[pathologyoutlines.com]
  • Glomerular filtration rate (eGFR CKD-EPI ) was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) study equation [ 13 ].[journals.plos.org]
Sex distribution
Age distribution

Pathophysiology

  • We precisely assessed both hepatic hemodynamics and hepatocellular function using sequential multidetector computed tomography and gadoxetate disodium-enhanced magnetic resonance imaging, which may provide useful information on the pathophysiological[ncbi.nlm.nih.gov]
  • Despite nearly 200 reports in the last 15 years on the hepato-biliary aspects of the sickling disorders, the frequency and pathophysiology of hepatic lesions remain unclear.[sickle.bwh.harvard.edu]
  • […] contraceptive pills, approximately 3 per 100,000 ( N Engl J Med 1976;294:470 ) Additional risk factors include anabolic steroids, noncontraceptive estrogen supplements, obesity and metabolic syndrome Mean age 37 - 41 years Rare in pediatric patients Pathophysiology[pathologyoutlines.com]

Prevention

  • In conclusion, when an operative injury to the hepatic artery is encountered, the hepatoduodenal ligament should not be manipulated any more than necessary to preserve the collaterals, and the gallbladder should be removed to prevent necrotic perforation[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Attention should be paid to inadvertent injury of hepatic artery to prevent hepatic infarction.[ncbi.nlm.nih.gov]
  • However, specific guidelines for the prevention of thrombosis in such patients have not been described.[edmcasereports.com]
  • Milk thistle (aka silymarin) is a dietary supplement traditionally used by herbalists to treat and to prevent damage to the liver. – Best food in NW Wisconsin –Local and Organic options: Helps the liver to regenerate There are many herbs and ingredient[pkpi.eu]
  • Systematic review: Preventive and therapeutic applications of metformin in liver disease. World J Hepatol. 2015;7:1652: Ampuero J, Ranchal I, Nuñez D, et al.[sapd.es]

References

Article

  1. Martinez VA, Garcia RC, Sauri CA, Mayayo AE, Oliver RJ. Hepatic infarction: an unusual complication of nephrotic syndrome in a patient with diabetes mellitus. Postgrad Med J. 1990;66(781):968-970.
  2. Maruyama M, Yamada A, Kuraishi Y, et al. Hepatic infarction complicated with acute pancreatitis precisely diagnosed with gadoxetate disodium-enhanced magnetic resonance imaging. Intern Med. 2014;53(19):2215–2221.
  3. Deng YG, Zhao ZS, Wang M, Su SO, Yao XX. Diabetes mellitus with hepatic infarction: a case report with literature review. World J Gastroenterol. 2006;12(31):5091–5093.
  4. Oh D, Park do H, Cho YW, et al. Hepatic infarction caused by vascular migration of fiducial marker previously under endosonographic guidance to assist radiotherapy. Endoscopy. 2014;46(suppl 1 UCTN):E585–E586.
  5. Bishehsari F, Ting P-S, Green RM. Recurrent gastrointestinal bleeding and hepatic infarction after liver biopsy. World J Gastroenterol. 2014;20(7):1878-1881.
  6. López-Méndez E, Zamora-Valdés D, Díaz-Zamudio M, Fernández-Díaz OF, Ávila L. Liver failure after an uncovered TIPS procedure associated with hepatic infarction. World J Hepatol. 2010;2(4):167-170
  7. Torabi M, Hosseinzadeah K, Federle MP. CT of nonneoplastic hepatic vascular and perfusion disorders. Radiographics. 2008;28(7):1967-1982
  8. Giovine S, Pinto A, Crispano S, Lassandro F, Romano L. Retrospective study of 23 cases of hepatic infarction: CT findings and pathological correlations. Radiol Med. 2006;111(1):11–21.
  9. Cook GJ, Crofton ME. Hepatic artery thrombosis and infarction: Evolution of the ultrasound appearances in liver transplant recipients. Br J Radiol. 1997;70(831):248-251.

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Last updated: 2018-06-22 06:18