Utility of Doppler ultrasonography for diagnosing and assessing treatment effects in liver compartment syndrome

Abstract

Liver compartment syndrome is a life-threatening complication of hepatic subcapsular hematoma; diagnosis and assessment of treatment effects are therefore important. We report a rare case of liver compartment syndrome due to spontaneous hepatic subcapsular hematoma without any underlying conditions, in which Doppler ultrasonography (US) proved useful in both diagnosis and assessment of treatment effects. A 32-year-old woman experienced sudden epigastralgia and was diagnosed with hepatic subcapsular hematoma in the right lobe, based on contrast-enhanced computed tomography. Hepatic arteriography showed active hemorrhage and Doppler US showed retrograde flow in the right portal vein. From these findings, we diagnosed hepatic subcapsular hematoma complicated with liver compartment syndrome, and performed embolization of the bleeding point and percutaneous hematoma drainage. After these medical procedures, normalized antegrade flow in the right portal vein was observed on Doppler US. No underlying conditions contributing to hematoma were identified. In this case, Doppler US was useful for both diagnosis and assessment of treatment effects in liver compartment syndrome. When we examine patients with hepatic subcapsular hematoma, Doppler US should be used to diagnose the presence of liver compartment syndrome and assess treatment effects.

Hepatic compartment syndrome, a rare complication after any liver insult or liver transplantation: Three case reports and literature review

“…Five cases (33.3%) were reported to be related to abdominal trauma [1,4,5], while nine (60.0%) were iatrogenic, secondary to procedures (cholecystectomies or percutaneous procedures) on the liver or gallbladder [3,[6][7][8][9], or perihepatic surgery on the right kidney, diaphragm, or the right adrenal gland [2,10,11]. The last case was spontaneous [12]. Interestingly, all cases were located on the right liver, and most patients presented hemodynamic instability (69.0%).…”

“…Indeed, when parenchyma decompression is clearly the main treatment for all authors, the technique use for decompression is either surgical or percutaneous. When percutaneous drainage is chosen by the authors, arterial embolization is said to be necessary when peripherical blushes are visible on CT scan [11,12]. However, for most authors who choose surgical decompression and hemostasis, no arterial embolization was necessary [1,2,5,[8][9][10].…”