Clinical characteristics, CT signs, and pathological findings of Pyrrolizidine alkaloids-induced sinusoidal obstructive syndrome: a retrospective study

Fang Liu,Chang Liu,Xuefeng Kan,Xinxin Rong,Tingting Guo,Lingling Meng,Yuhu Song,Hui Guo,Dong Xu,Xiaoqian Yang

doi:10.1186/s12876-020-1180-0

Abstract

BackgroundOne major etiology of hepatic sinusoidal obstruction syndrome (HSOS) in China is the intake of pyrrolizidine alkaloids (PAs). Since PAs-induced HSOS is a rare disease that has not been clearly characterized until now, the aim of this study was to investigate clinical characteristics, CT features, and pathological findings of PA-induced HSOS.MethodsThis retrospective cohort study included 116 patients with PAs-induced HSOS and 68 patients with Budd-Chiari syndrome from Jan 2006 to Sep 2016. We collected medical records of the patients, and reviewed image features of CT, and analyzed pathological findings.ResultsCommon clinical manifestations of PAs-induced HSOS were abdominal distention (98.26%), ascites (100%), jaundice (52.94%), abdominal pain (36.36%). Abnormal liver function was observed in most of PAs-induced HSOS. On CT scan, common findings included: ascites, hepatomegaly, the thickening of gallbladder wall, pleural effusion, patchy liver enhancement, and heterogeneous hypoattenuation. Most of the patients had a low ascitic total protein (< 25 g/L) and a high SAAG (≥ 11.0 g/L). In acute stage, pathologic features were massive sinusoidal dilatation, sinusoidal congestion, the extravasation of erythrocytes, hepatocellular necrosis, the accumulation of macrophages, the deposition of hemosiderin. In subacute stage, complete loss of pericentral hepatocytes, sinusoidal dilatation, the deposition of pigment granules were observed.ConclusionsThe PAs-induced HSOS patients displayed distinct clinical characteristics, imaging features, and pathological findings, which provided some evidences for the diagnosis of PAs-induced HSOS.Trial registrationChiCTR-DRD-17010709.

Highlights

One major etiology of hepatic sinusoidal obstruction syndrome (HSOS) in China is the intake of pyrrolizidine alkaloids (PAs)
Clinical presentation In this study, 116 patients with a diagnosis of PAsinduced Hepatic sinusoidal obstruction syndrome (HSOS) were enrolled in our study
In PAs-induced HSOS patients, there were 78 males and 38 females, with a male-to-female ratio of 2.05:1. It indicated that the patients with older age and male gender were frequently affected

Summary

Introduction

One major etiology of hepatic sinusoidal obstruction syndrome (HSOS) in China is the intake of pyrrolizidine alkaloids (PAs). Since PAs-induced HSOS is a rare disease that has not been clearly characterized until now, the aim of this study was to investigate clinical characteristics, CT features, and pathological findings of PAinduced HSOS. Hepatic sinusoidal obstruction syndrome (HSOS), known as veno-occlusive disease (VOD), is characterized by damage to sinusoidal endothelium [1, 2]. China [12,13,14].In view of the difference in the etiology of HSOS, clinical profiles and imaging findings of HSOS associated with HSCT or oxaliplatin might be hardly extrapolated to PAs-induced HSOS. Clinical profiles, CT features, and pathological finding of PAs-induced HSOS were investigated in our study

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