Hepatic Lobe Lesions Research Articles

Transient Liver Masses during Pregnancy: An Unusual Presentation of HELLP Syndrome

Introduction: HELLP (microangiopathic hemolytic anemia, elevated liver enzymes, low platelet count syndrome) and acute fatty liver of pregnancy (AFLP) are liver diseases unique to pregnancy primarily affecting women in their third trimester. Early diagnosis and prompt treatment is crucial for maternal and fetal survival. We present a case of HELLP syndrome with unusual focal fatty liver lesions that resolved completely after delivery. Case Report: A 37-year-old healthy female, G1P0 at 27 week gestation, was transferred from an outside hospital with a week of severe right upper quadrant abdominal pain bloating, nausea and vomiting and liver masses concerning for malignancy. Ultrasound of the abdomen performed one week prior to the transfer showed two predominantly echogenic right hepatic lesions measuring 2.9 cm and 3.5 cm. A non-contrast MRI was also performed and demonstrated two right hepatic lobe lesions measuring 3.2 cm and 3 cm in diameter. Both lesions had slightly decreased signal intensity on the T1 weighted images and slightly increased signal intensity on the T2 weighted images. Repeat RUQ ultrasound at admission demonstrated a normal gallbladder and biliary tree. There were now five echogenic areas within the liver with lobular or indistinct margins measuring between 1.2 and 7.2 cm. There was no displacement of the vasculature surrounding these echogenic areas which were suggestive for fatty infiltration or hemangiomas. Laboratory abnormalities included mild leukocytosis, low platelets, elevated LDH, hypoglycemia, elevated transaminases (AST 99 U/L, ALT 132 U/L) and normal alkaline phosphatase. Pregnancy was complicated by prolonged fetal deceleration/bradycardia despite resuscitative efforts and positional changes, resulting in an emergent cesarean section. She recovered uneventfully, and her liver transaminases normalized within 5 days after delivery. A repeat MRI 1 month post delivery, showed complete resolution of her previously seen liver lesions. Conclusion: Focal fatty infiltration of the liver may closely mimic nodular hepatic disease. Although metastatic disease is the most common cause of multiple nodular lesions of the liver, focal fatty infiltration should be considered in pregnancy. Typical MRI findings include drop out of fat on the out of phase T1 images with respect to the T1 in phase images. Common hepatic manifestations in HELLP syndrome include hemorrhage, hematoma or liver rupture. It is uncommon to have significant focal fatty infiltrates in liver during HELLP. The significant overlap between HELLP and AFLP and the focal fatty infiltrates in liver during HELLP may reflect a common pathogenic pathway between the two.

The prevalence and variations of inferior right hepatic veins on contrast-enhanced helical CT scanning

Purpose: To present the prevalence and variations of inferior right hepatic veins (IRHVs) on contrast-enhanced helical computed tomography (CEHCT) scans. Materials and methods: The routine abdominal CEHCT scans of 349 patients were reviewed. Three hundred and eight patients (88.2%) were included in the study. Of the 349 patients, 41 (11.8%) were excluded from the study because of improper opacification of hepatic veins and right hepatic lobe lesions which made difficult the optimal visualization and assessment of IRHVs. The mean age of 308 patients was 43 years (range 3–97 years). One hundred and forty-three patients (46.4%) were men and 165 (53.6%) women. Scans were examined whether the IRHVs were demonstrated or not and classified according to their numbers, levels, diameters, and joinings to inferior vena cava (IVC). Results: Of the 308 patients, 65 (21.1%) had one or two IRHVs. Fifty-four patients (83.1%) had only one IRHV and 11 (16.9%) patients had two. More than two IRHVs were not seen in any patient. Eight (72.7%) of 11 double IRHVs joined the IVC at the same level and others (27.3%) did not. There was no truncal opening to the IVC. In five patients (7.7%) the IRHV were large (≥0.5 cm). Conclusion: The presence of IRHVs is common and routine CEHCT scanning is efficacious in assessment of IRHVs.