Acute-on-chronic liver failure due to infarction of multiple cirrhotic nodules.

Abstract

A 49-year-old man with chronic hepatitis B virus infection was admitted for hematemesis. Esophagogastroduodenoscopy revealed active bleeding from the lower esophageal varix and endoscopic variceal ligation was successfully performed (Figure 1A). CT showed diffuse shrinkage and surface nodularity of the liver with multiple hypo-attenuated spots (Figure 1B). Liver function deteriorated rapidly, and liver transplantation was performed. Grossly, the explant had numerous cirrhotic nodules, some of which were yellow-colored (Figure 1C). Numerous regenerative nodules were observed on the microscopic examinations. Of note, a considerable number of nodules, which were observed as dark spots on CT scans and as yellow-colored areas grossly, were filled with necrotic materials suggesting that these nodules were infarcted (Figure 1D).