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 . 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 . Other elements that increase the risk of HI entail vasoconstrictors that act centrally (thus affecting the blood supply of abdominal organs), atherosclerosis and pancreatitis   .
Patients with HI may be asymptomatic . In the symptomatic individuals, onset is sudden, and common complaints are right upper quadrant pain, fever, jaundice and gastrointestinal upset . 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.
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 . The site, extent and possible underlying pathology of the HI can be assessed using a CT scan . 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 .
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  . 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).