Acute fatty liver of pregnancy and diagnosis by computed tomography.

Abstract

A 39 year old woman was admitted to a maternity unit at 34 weeks' gestation with nausea, vomiting, and jaundice. Her condition deteriorated, and she was transferred to hospital, deeply unconscious and hypotensive. The diagnosis of acute fatty liver of pregnancy was initially suggested by the typical history of prodromal malaise and vomiting and the rapid onset of hepatic encephalopathy with profound hypoglycaemia and only small increases in transaminase activities. Computed tomography was performed: there was no enlargement of the liver or spleen, but the attenuation value over the liver indicated appreciable fatty infiltration of the liver, establishing the diagnosis of acute fatty liver of pregnancy.

HELLP Syndrome: CT Evaluation

“…This observation, com bined with other reports [6][7][8][9][10] that reduced liver CT numbers are obtained in acute fatty liver of pregnancy, led to the expectation that liver-spleen CT number ratios obtained in the early postpartum period in patients with HELLP syndrome would be substantially decreased. However, only 3 cases with more severe thrombocytope nia showed a slight decrease in liver-spleen CT number ratios, suggesting the presence of fatty liver [11], Although liver specimens were not obtained from any of our patients for ethical reasons [12], these 3 patients might have had livers with a wider distribution of relatively large fat droplets [5].…”

“…Marked reductions in liver-spleen CT number ratios have been reported in acute fatty liver of pregnancy [6][7][8][9][10], but those patients experienced truly severe clinical conditions, such as jaundice, coagulopathy, mental deteri oration, and/or intrauterine fetal death. Their clinical condition could have been linked to a delay in medical intervention [2,3].…”

“…It is unlikely that the CT number of liver is largely affected by parturition itself in several days. A marked reduction in liver CT number, which reflects massive fatty infiltration [6][7][8][9], can occur rapidly in severe clinical conditions.…”

“…Liver histology in both conditions is the same and is characterized by fatty infil tration of the hepatocytes [5], There have been several iso lated reports of acute fatty liver of pregnancy diagnosed by computed tomography (CT) that showed a reduced liv er-spleen CT number ratio [6][7][8][9][10], However, no systemat ic study has been reported on the clinical usefulness of antenatal determination of the liver-spleen CT number ratio in patients who are at risk for peripartum HELLP syndrome. We designed this study to resolve the issue.…”

Transient Nephrogenic Diabetes Insipidus Associated with Acute Hepatic Failure in Pregnancy

“…However, in the present patient computed tomography and ultrasound examination did not establish the diagnosis of acute fatty liver of pregnancy. McKee et al (1986) reported that computed tomography established the diagnosis of acute fatty liver of pregnancy within three hours of admission because of acute hepatic failure, but the same examination did not show remarkable changes in liver eight days after delivery. In the present patient computed tomography was performed nine days after delivery when remarkable changes in liver might disappear.…”