Hepatic infarction in preeclampsia.

Abstract

Two cases of hepatic infarction in toxemia of pregnancy are described. Both patients had associated laboratory findings of the HELLP syndrome (hemolytic anemia, elevated liver enzyme levels, and low platelet levels). Computed tomography (CT) showed nonenhancing low-attenuation areas varying in configuration from peripheral, well-defined, wedge-shaped lesions to larger abnormalities. Magnetic resonance imaging showed a corresponding area of low signal intensity on T1-weighted images with high signal intensity on T2-weighted images. Ultrasound showed several well-defined peripheral hypoechoic areas. The low attenuation and lack of enhancement on CT scans and the absence of mass effect are the key distinguishing features.

Hepatic infarction in preeclampsia as part of the HELLP syndrome: CT appearance

“…There have been few reports of the CT appearance of liver infarcts in HELLP syndrome [3,7]. In both our cases and in those reported in the literature, CT showed inhomogeneous areas of low attenuation, either wedge-shaped peripherally or geographically when larger, with enhanced vessels coursing through these areas, indicating lack of mass effect.…”

Retrospective study of 23 cases of hepatic infarction: CT findings and pathological correlations

“…Pre-eclampsia is a relatively rare (5%) toxaemia of the third-trimester of pregnancy, which is characterised by hypertension, proteinuria and oedema and possible seizures and coma in the more severe form (eclampsia), and is at times associated with disseminated intravascular coagulation [32,33]. A small number of patients with pre-eclampsia develop signs of liver dysfunction, with elevated liver enzymes, haemolysis and low platelet count.…”

An unusual case of elevated liver enzymes (2006: 10b)

“…Severe eclampsia is characterised by hypertension, oliguria, proteinuria, pulmonary oedema, cerebral and visual disturbances [4]. HELLP syndrome is the most life-threatening consequence of severe eclampsia and this syndrome is characterised by microvascular endothelial damage and intravascular platelet activation.…”

“…CT is the main imaging modality in the post-pregnancy stage hepatic necrosis and infarction can be seen as non-enhancing low attenuation areas without mass effect [3]. In the pregnant patient, ultrasound and MRI may be used to evaluate the liver due to their lack of ionising radiation [3][4][5].…”