A 57 year old man with chronic renal failure and cardiac tamponade who developed ischemic hepatitis

López-Méndez, Eric; López-Méndez, Eduardo; López-Méndez, Iván; Hernández-Reyes, Pablo; Galindo-Uribe, Jaime; Angulo-Ramírez, Vanessa; Avila-Escobedo, Lourdes; Uribe, Misael

doi:10.1016/s1665-2681(19)32041-1

Cited by 4 publications

(5 citation statements)

References 8 publications

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“…Over the past 20 years, a literature review yielded 6 patients of chronic kidney disease (CKD) associated with IH due to CT (Table 2) [4][5][6][7][8][9]. Underlying conditions that caused CT were as follows: adenocarcinoma of the lung was detected in 2 cases [7,8], uremic pericarditis in one [9], and 3 cases had unknown etiology [4][5][6]. Four patients were on HD [4,5,7,9], and 1 patient received HD for deterioration of CKD stage V [6].…”

Section: Discussionmentioning

confidence: 99%

“…Underlying conditions that caused CT were as follows: adenocarcinoma of the lung was detected in 2 cases [7,8], uremic pericarditis in one [9], and 3 cases had unknown etiology [4][5][6]. Four patients were on HD [4,5,7,9], and 1 patient received HD for deterioration of CKD stage V [6]. All patients showed collapse of cardiac chambers on echocardiography.…”

Section: Discussionmentioning

confidence: 99%

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Ischemic Hepatitis Induced by Uremic Cardiac Tamponade in a Patient with Underlying Hepatitis C with a Review of the Literature

Alsultan

Bakr

Hassan

2022

Case Rep Gastroenterol

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Ischemic hepatitis is a rare cause of acute liver injury (ALI) and is associated with various etiologies including cardiac failure, trauma, hemorrhage, and respiratory failure that all result in poor perfusion and oxygen delivery to the liver. A 30-year-old patient complained of orthopnea with a history of hepatitis C treatment and is currently on hemodialysis (HD) due to chronic allograft rejection. Also, he had previous pericardial effusion (PEFF) due to inadequate dialysis. Laboratory tests on admission revealed urinary tract infection, HCV PCR positive, and high blood urea nitrogen. Computed tomography of the chest showed massive PEFF. Echocardiography revealed a massive PEFF that measured 3.6 cm on the apical four-chamber window, and the inferior vena cava diameter was 27 mm with a decreased collapsibility of ˂20% in inspiration. The patient was treated for UTI and started the treatment for HCV. Also, increased HD sessions with minimal heparinization of the dialyzer circuit were obtained along with daily monitoring of PEFF by echocardiography. At first, echocardiography did not reveal frank signs of cardiac tamponade, but after 2 sessions of HD, the patient developed chest pain, worsening orthopnea, JVP elevation, and dropping of the systolic BP. Echocardiography showed specific signs of cardiac tamponade, which included an increased effusion to 4.4 cm and changes in velocities of the mitral valve and tricuspid valve during the respiratory cycle by more than 25% and 40%, respectively. The patient was transmitted to ICU, and pericardiocentesis was obtained. Two days later, asymptomatic ALI was noticed by elevation of the following tests: ALT, AST, LDH, PT, and INR. However, ALI exhibits a rapid and spontaneous resolution to nearly normal tests after 10 days. Although the patient was hemodynamically stable, the liver injury occurred and might be attributed to ESRD and hypertension that caused thickened heart walls, diastolic dysfunction, and subsequently hepatic congestion, in addition to previous liver injury due to HCV. We present a rare case of ALI caused by uremic pericardial tamponade with an overview of the current literature with regard to this entity. So, we emphasize monitoring liver function tests in the context of PEFF, especially in patients with chronic kidney disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ischemic Hepatitis Induced by Uremic Cardiac Tamponade in a Patient with Underlying Hepatitis C with a Review of the Literature

Alsultan

Bakr

Hassan

2022

Case Rep Gastroenterol

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“…El patrón bioquímico típico de la HI consis- te en una rápida y marcada elevación de las transaminasas séricas asociado a un incremento importante de los niveles de LDH. En ausencia de un insulto hemodinámico permanente, las cifras de transaminasas descienden de forma progresiva, generalmente normalizándose en el plazo de 7-10 días 5 .…”

Section: Discussionunclassified

Ischemic hepatitis secondary to cardiac tamponade, a rare cause

Esarte

Urmeneta

Esarte³

et al. 2016

An Sist Sanit Navar

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Ischemic hepatitis (IH) is a rare entity, usually associated with hypoperfusion secondary to low cardiac output (congestive heart failure, acute myocardial infarction or dilated cardiomyopathy), followed in frequency by respiratory insufficiency and sepsis. A 49-year-old man presented at the emergency room with progressive dyspnea and hypotension, objectifying a significant increase in transaminases (aspartate transferase 5.550 U / L, alanine transferase 3.826 U / L) and LDH (10.375 U / L). Liver Doppler ultrasound was normal. The echocardiogram confirmed the suspected diagnosis of massive pericardial effusion. Cardiac tamponade is a rare cause for this clinical picture. In the case of our patient, rapid diagnosis and urgent pericardiocentesis led to his prompt recovery.

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“…In the absence of telltale signs and symptoms of tamponade, clinicians must be suspicious of tamponade when evaluating a patient for ischemic hepatitis. Several cases of tamponade resulting in ALI have been reported, yet these patients either presented with signs and symptoms of outright tamponade or had malignancy resulting in pericardial effusion, recent cardiothoracic surgery, or Mycobacterium tuberculosis infection, our case had none of these [ 7 - 11 ]. Cardiac tamponade is a clinical diagnosis.…”

Section: Reviewmentioning

confidence: 93%

“…Differential diagnosis includes viral and autoimmune hepatitis, direct liver trauma, vascular disease, toxin-induced such as acetaminophen ingestion, and biliary obstruction secondary to lithiasis. Liver biopsy is rarely performed and usually reveals centrilobular necrosis [ 4 , 7 ]. Pathological changes related to ischemic hepatitis are usually observed in zone III near the central vein [ 4 ].…”

Section: Reviewmentioning

confidence: 99%

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

Thaker

Yazıcı

Koppe

2018

Cureus

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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.

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A 57 year old man with chronic renal failure and cardiac tamponade who developed ischemic hepatitis

Cited by 4 publications

References 8 publications

Ischemic Hepatitis Induced by Uremic Cardiac Tamponade in a Patient with Underlying Hepatitis C with a Review of the Literature

Ischemic Hepatitis Induced by Uremic Cardiac Tamponade in a Patient with Underlying Hepatitis C with a Review of the Literature

Ischemic hepatitis secondary to cardiac tamponade, a rare cause

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

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