Hepatic Infarction Complicated with Acute Pancreatitis Precisely Diagnosed with Gadoxetate Disodium-enhanced Magnetic Resonance Imaging

Abstract

Pancreatitis may induce a spectrum of venous and arterial vascular complications. However, hepatic infarction complicated with acute pancreatitis seldom occurs because of the unique vascular configuration of the liver. We herein describe an extremely rare and unique case in which simultaneous portal vein and hepatic vein thrombosis were present. We precisely assessed both hepatic hemodynamics and hepatocellular function using sequential multidetector computed tomography and gadoxetate disodium-enhanced magnetic resonance imaging, which may provide useful information on the pathophysiological state and diagnosis of hepatic infarction.

Hepatic infarction from portal vein thrombosis: A fatal consequence of acute pancreatitis

“…On the other hand, hepatic insult from portal vein thrombosis is usually mild due to its dual blood supply and hepatic infarction is exceedingly rare . Common causes of hepatic infarction are iatrogenic due to liver inflow occlusion during surgery or transarterial angiographic procedures . Though clear associations are not detected in most cases, antiphospholipid syndrome, arteriosclerosis, polyarteritis nodosa, sepsis‐induced disseminated intravascular coagulation, non‐obstructive intestinal ischemia, hemolysis, elevated liver enzymes, low platelet count syndrome and trauma have all been reported to be able to cause hepatic infarction .…”

“…As a magnetic resonance (MR) contrast medium, gadoxetate disodium is distributed predominantly in the extracellular fluid space at the early phase and in hepatocytes in the hepatobiliary phase. This property makes gadoxetate disodium‐enhanced MR imaging an attractive tool for evaluating hepatocellular function in the hepatobiliary phase . However, it is time‐consuming and difficult to perform in a critically ill patient.…”

“…5 A surge in proinflammatory mediators, stasis, vascular spasm, pressure from the inflamed pancreas and peripancreatic tissues, and direct enzymatic damage of the venous wall result in pancreatitis-induced venous thrombosis. 8,9 Though some cases of thromboses resolve over time, nearly half progress to collateral formation. 5 Splanchnic thrombosis from acute pancreatitis may cause visceral infarction involving the spleen, small bowel or liver.…”

“…This property makes gadoxetate disodium-enhanced MR imaging an attractive tool for evaluating hepatocellular function in the hepatobiliary phase. 9 However, it is time-consuming and difficult to perform in a critically ill patient.…”

Spontaneous Hepatic Infarction in a Patient with Gallbladder Cancer

“…However, special occasions with combined multiple risk factors or iatrogenic causes can predispose nontransplanted patients to this rare disease entity. Based on previous reports, trauma, underlying hypercoagulability, atherosclerosis, use of splanchnic vasoconstrictor agents, pancreatitis, previous vascular intervention including transcatheter arterial embolization or intra-arterial chemoinfusion for hepatocellular carcinoma, hepatic artery pseudo-aneurysm after an invasive hepatic procedure, and systemic hypotension have been presented as possible causes of hepatic infarction [ 1 , 2 , 3 , 4 , 5 , 6 ]. Although other malignancies except hepatocellular carcinoma have not been presented as a risk factor for hepatic infarction, theoretically they, especially biliary malignancies, can be a predisposing factor in some respects.…”