Hepatic involvement in HELLP syndrome: an update with emphasis on imaging features

Abstract

HELLP syndrome, which consists of hemolysis, elevated liver enzymes, and low platelet count is an unusual complication of pregnancy that is observed in only 10% to 15% of women with preeclampsia. Hepatic involvement in HELLP syndrome may present with various imaging features depending on the specific condition that includes nonspecific abnormalities such as perihepatic free fluid, hepatic steatosis, liver enlargement, and periportal halo that may precede more severe conditions such as hepatic hematoma and hepatic rupture with hemoperitoneum. Maternal clinical symptoms may be nonspecific and easily mistaken for a variety of other conditions that should be recognized. Because hepatic hematoma occurring in association with preeclampsia and HELLP syndrome is a potentially life-threatening complication, prompt depiction is critical and may help reduce morbidity and mortality. This review provides an update on demographics, risk factors, pathophysiology, and clinical features of hepatic complications due to HELLP syndrome along with a special emphasis on the imaging features of these uncommon conditions.

Liver rupture in a 28‐year‐old primigravida with superimposed pre‐eclampsia and hemolysis, elevated liver enzyme levels, and low platelet count syndrome

“…In obstetrics, ultrasound is a simple and readily available tool to detect major abnormalities, such as hematomas, ruptures or free intraabdominal fluid. The use of magnetic resonance imaging (MRI) as a first‐line imaging technique is not recommended unless in the case of suspect ultrasound findings in a clinically stable patient . Up to 47% of HELLP syndrome patients have abnormal but nonspecific hepatic findings in the imaging .…”

“…The use of magnetic resonance imaging (MRI) as a first‐line imaging technique is not recommended unless in the case of suspect ultrasound findings in a clinically stable patient . Up to 47% of HELLP syndrome patients have abnormal but nonspecific hepatic findings in the imaging . Therefore, the use of ultrasound and MRI should aim to identify life‐threatening hepatic complications, mostly indicated through free intraabdominal fluid …”

“…Up to 47% of HELLP syndrome patients have abnormal but nonspecific hepatic findings in the imaging . Therefore, the use of ultrasound and MRI should aim to identify life‐threatening hepatic complications, mostly indicated through free intraabdominal fluid …”

“…9,10 Up to 47% of HELLP syndrome patients have abnormal but nonspecific hepatic findings in the imaging. 9,11 Therefore, the use of ultrasound and MRI should aim to identify life-threatening hepatic complications, mostly indicated through free intraabdominal fluid. 9 In cases of suspected liver complications, the clinical status of mother and fetus is essential for any further therapeutic decision.…”

The Yield of Abdominal Ultrasound in the Evaluation of Elevated Liver Enzymes during the Second and the Third Trimester of Pregnancy

“…HELLP syndrome might present with various hepatic features that can be revealed using sonography including perihepatic free fluid, hepatic steatosis, liver enlargement, and periportal halo [17] . These findings may precede more severe conditions such as hepatic hematoma and hepatic rupture with hemoperitoneum [18][19][20] . However, these findings are uncommon at the time of diagnosis and usually the aim of sonographic evaluation is to rule out other possible diagnoses.…”