Isolated Hepatic Artery Thrombosis Leading to Multiple Liver Infarcts in a Non-transplant Patient

Abstract

Patient: Female, 62Final Diagnosis: Hepatic artery thrombosisSymptoms: Abdominal pain • Nausea • VomitingMedication: —Clinical Procedure: —Specialty: SurgeryObjective:Rare diseaseBackground:Isolated hepatic artery thrombosis is an extremely rare condition with only a few cases reported in the literature.Case Report:A 62-year-old woman presented with a 5-day history of right upper quadrant abdominal pain associated with nausea and vomiting. Physical examination revealed right upper quadrant tenderness.Her initial laboratory work was significant for elevated aspartate aminotransferase and alanine aminotransferase levels (745 and 431 U/L, respectively).A computed tomography of her abdomen showed a thrombus within the hepatic artery, with multiple hepatic infarcts but no evidence of portal vein thrombosis. Hypercoagulability workup was unremarkable; she did not have any evidence of atrial fibrillation on ECG or telemetry. She was treated with subcutaneous low molecular weight heparin.Over the course of her hospitalization, her AST and ALT levels peaked to 2065 and 1217 U/L respectively, and trended down thereafter.Conclusions:We believe that our case is unique for 2 reasons: 1) Our patient did not undergo any procedure that may have precipitated hepatic artery thrombosis and 2) Despite the absence of concurrent portal vein thrombosis, she had biochemical and imaging findings of hepatic ischemia.

Spontaneous Hepatic Infarction in a Patient with Gallbladder Cancer

“…She eventually expired even though her liver enzyme levels had decreased 3 days after the episode. Many other previous reports also showed a poor outcome irrespective of anticoagulation treatment [ 15 , 16 ].…”

Spontaneous cessation of postpancreatectomy hemorrhage in a patient with celiac artery stenosis

“…Spontaneous hepatic artery thrombosis is an extremely rare emergency, presenting with liver infarction. To the date, there are only 4 cases described in literature [15] , [16] , [17] , [18] . Rate of asymptomatic thromboses is unknown, although it is clear that liver arterial exclusion without sufficient collaterals leads to severe and often fatal consequences.…”