Importance of computed tomography imaging features for the diagnosis of autoimmune acute liver failure

Yasui, Shin; Fujiwara, Keiichi; Okitsu, Koichiro; Yonemitsu, Yutaka; Ito, Hisao; Yokosuka, Osamu

doi:10.1111/j.1872-034x.2011.00892.x

Cited by 51 publications

(61 citation statements)

References 20 publications

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“…Most patients with acute presentation of AIH do not present an elevated immunoglobulin G (IgG) level or high titer of ANA, which is characteristic of AIH . Furthermore, it is often difficult to perform liver biopsy due to the complicated coagulopathy and ascites in patients with acute liver failure . A recent report showed that heterogeneous hypoattenuation on unenhanced CT is a characteristic CT imaging feature of autoimmune acute liver failure compared with viral acute liver failure .…”

Section: Discussionmentioning

confidence: 99%

Pregnant woman with non‐comatose autoimmune acute liver failure in the second trimester rescued using medical therapy: A case report

Sato

Tomita

Yasue

et al. 2014

Hepatology Research

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We present the case of a 25-year-old woman at 16 weeks of gestation who presented with non-comatose autoimmune acute liver failure and was at high risk of developing fulminant hepatitis. Predictive formulas indicated a high probability of developing fulminant hepatitis. Unenhanced computed tomography showed marked hepatic atrophy and broadly heterogeneous hypoattenuating areas. The course of her illness was subacute, and the etiology of liver injury was unclear. Considering all of the above, we predicted a poor prognosis. Plasma exchange (PE) and continuous hemodiafiltration (CHDF) therapy were initiated just after admission. A few days after admission, a high titer (×80) of antinuclear antibody was noted. Because autoimmune hepatitis (AIH) was considered a cause of liver failure, treatment with moderate prednisolone (30 mg/day) doses was administrated, with careful consideration of her pregnancy. Thereafter, her laboratory findings and clinical course gradually improved without the need for liver transplantation. A liver biopsy at 18 days after admission indicated a diagnosis of AIH. She continued the pregnancy and delivered a healthy baby without any complications. Eventually, prednisolone doses were decreased to 10 mg, after which her liver function worsened. The second liver biopsy also indicated a diagnosis of AIH. Accordingly, low-dose prednisolone and azathioprine doses (50 mg/day) were administrated to recover her liver function, after which her liver function regained normalcy. This case illustrates that a pregnant woman with non-comatose autoimmune acute liver failure in the first or second trimester of pregnancy and her fetus can be rescued by PE/CHDF therapy and safe moderate doses of prednisolone.

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Section: Discussionmentioning

confidence: 99%

Pregnant woman with non‐comatose autoimmune acute liver failure in the second trimester rescued using medical therapy: A case report

Sato

Tomita

Yasue

et al. 2014

Hepatology Research

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“…All laboratory tests and CT scans were obtained at the initial presentation. The presence and patterns of hypoattenuating areas in the liver on the CT scans were subjectively assessed . Liver biopsies were carried out within a week of the referral.…”

Section: Methodsmentioning

confidence: 99%

Increasing incidence of elderly‐onset autoimmune hepatitis

Morii

Nagano

Yamamoto

et al. 2016

Geriatrics Gerontology Int

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“…Other than assessing features of portal hypertension, imaging has a limited value as a diagnostic tool in AS‐AIH. Unenhanced computed tomography (CT) can demonstrate heterogenous hypoattenuated regions within the liver in 65% of patients with AIH‐associated ALF when compared with patients with viral‐associated ALF . Liver volume on CT is significantly reduced in nonacetaminophen cases of acute liver injury (ALI)/ALF when compared with acetaminophen‐induced ALI/ALF …”

Section: Epidemiologymentioning

confidence: 99%

Acute Severe Autoimmune Hepatitis: Corticosteroids or Liver Transplantation?

et al. 2019

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Acute severe presentations of autoimmune hepatitis (AIH) represent a challenge for the transplant community. As a disease, it is poorly characterized, and there is a weak evidence base to guide diagnosis and treatment. Early identification of acute severe AIH is key because it determines the initiation of corticosteroids, which can be lifesaving. However, their use in this setting remains controversial. The Model for End‐Stage Liver Disease score, severity of coagulopathy, and grade of encephalopathy may be predictors of outcome with corticosteroid therapy. The optimal timing of liver transplantation (LT) can be difficult to determine and, as such, the decision to proceed to transplantation should not be delayed by protracted courses of corticosteroids. The aim of this review is to better characterize this subset of patients; to differentiate them clinically, serologically, and histologically from chronic AIH and other causes of acute liver failure; and to present the role, predictors, and optimal timings of corticosteroid therapy and LT. Although this review is specific to adults, many principles hold true for the pediatric population.

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Importance of computed tomography imaging features for the diagnosis of autoimmune acute liver failure

Abstract: Heterogeneous hypoattenuation on unenhanced CT was a characteristic CT imaging feature of autoimmune acute liver failure compared with viral ALF. This finding could be one of the tools for diagnosing autoimmune acute liver failure in combination with clinicopathological features.

Cited by 51 publications

References 20 publications

Pregnant woman with non‐comatose autoimmune acute liver failure in the second trimester rescued using medical therapy: A case report

Pregnant woman with non‐comatose autoimmune acute liver failure in the second trimester rescued using medical therapy: A case report

Increasing incidence of elderly‐onset autoimmune hepatitis

Acute Severe Autoimmune Hepatitis: Corticosteroids or Liver Transplantation?

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