Atypical Presentation of Cardiac Tamponade as a Cause of Acute Liver Injury: Case Report and Review of Literature.

Sarang Thaker,Sean Koppe,Cemal Yazici

doi:10.7759/cureus.2779

Sarang Thaker, Sean Koppe + Show 1 more

Open Access

https://doi.org/10.7759/cureus.2779

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Journal: Cureus	Publication Date: Jun 11, 2018
Citations: 4	License type: cc-by

Affiliation: University of Illinois at Chicago

Abstract

Pericardial tamponade is a rare cause of acute liver injury due to the compressive effects of an effusion resulting in a poor cardiac output which ultimately leads to ischemia-induced injury. We present a patient with chronic hepatitis C infection and end-stage renal disease who was transferred to our center for further evaluation and management of acute liver injury after presenting to an outside hospital with left upper quadrant abdominal pain, nausea and vomiting. The patient was discovered to have tamponade physiology on transthoracic echocardiogram as an underlying cause of his acute liver injury despite lack of clinical tamponade features. He required pericardiocentesis which eventually led to resolution of the acute liver injury and he was discharged home on day twelve after full recovery. We review the existing literature regarding the epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment of ischemic hepatitis, which is associated with high mortality; therefore early recognition and treatment of the underlying cause are paramount.

Highlights

Ischemic hepatitis is a rare cause of acute liver injury (ALI) and is associated with various etiologies including acute cardiac failure, trauma, hemorrhage, and respiratory failure that all result in poor perfusion and oxygen delivery to the liver [1]
We present a rare case of ALI caused by pericardial tamponade in a patient with hepatitis C infection (HCV) and end-stage renal disease (ESRD) which required pericardiocentesis, leading to resolution of ALI
In patients with chronic respiratory failure, treatment should be directed towards correcting hypoxemia as well as treating the underlying cause with supplemental oxygen, possible ventilatory support, nebulized beta-agonists and anticholinergics, corticosteroids, and possibly antimicrobials [34]

Summary

Introduction

Ischemic hepatitis is a rare cause of acute liver injury (ALI) and is associated with various etiologies including acute cardiac failure, trauma, hemorrhage, and respiratory failure that all result in poor perfusion and oxygen delivery to the liver [1]. The group concluded that hypotension alone did not lead to ischemic hepatitis and noted that each patient that developed ischemic hepatitis had underlying cardiac disease, most commonly right-sided heart failure, which caused hepatic congestion. This study revealed that cardiac compromise leads to liver ischemia, respiratory compromise causes hypoxemia resulting in hepatic injury, and septic and hypovolemic shock lead to an inability for the body to meet hepatic oxygenation demands [1]. In patients with chronic respiratory failure, treatment should be directed towards correcting hypoxemia as well as treating the underlying cause with supplemental oxygen, possible ventilatory support, nebulized beta-agonists and anticholinergics, corticosteroids, and possibly antimicrobials [34] As noted above, both restrictive and obstructive lung disease patients can develop ischemic hepatitis; the etiology of chronic respiratory failure should be managed with its respective treatment [23]. Roughly one-half of patients with acute liver injury due to ischemic hepatitis do not survive to discharge, it is paramount that early recognition and diagnosis be made in order to expedite treatment [19]

Conclusions

Disclosures

Ebert EC

Findings

12. Spodick DH