Multiple hepatic infarctions secondary to diabetic ketoacidosis: A case report
Hepatic infarctions (HI) are ischemic events of the liver in which a disruption in the blood flow to the hepatocytes leads to focal ischemia and necrosis. Most HI are due to occlusive events in the liver's blood vessels, but non-occlusive HI may occur. They are associated with disruption of mic...
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Published in | World journal of hepatology Vol. 14; no. 11; pp. 1977 - 1984 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Baishideng Publishing Group Inc
27.11.2022
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Subjects | |
Online Access | Get full text |
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Summary: | Hepatic infarctions (HI) are ischemic events of the liver in which a disruption in the blood flow to the hepatocytes leads to focal ischemia and necrosis. Most HI are due to occlusive events in the liver's blood vessels, but non-occlusive HI may occur. They are associated with disruption of microvasculature, such as in diabetic ketoacidosis. While HI usually presents as peripheral lesions with clear borders, irregular nodular lesions may occur, indistinguishable from liver neoplasms and presenting a diagnostic challenge.
We report a case of multiple extensive HI in a patient with poorly controlled diabetes mellitus, who first presented to the emergency room with diabetic ketoacidosis. He then developed jaundice, thrombocytopenia, and a marked elevation of serum aminotransferases. An ultrasound of the liver showed the presence of multiple irregular lesions. Further investigation with a computerized tomography scan confirmed the presence of multiple hypoattenuating nodules with irregular borders and heterogeneous appearance. These lesions were considered highly suggestive of a primary neoplasm of the liver. While the patient was clinically stable, his bilirubin levels remained persistently elevated, and he underwent an ultrasound-guided percutaneous biopsy of the largest lesion. Biopsy results revealed extensive ischemic necrosis of hepatocytes, with no signs of associated malignancy. Three months after the symptoms, the patient showed great improvement in all clinical and laboratory parameters and extensive regression of the lesions on imaging exams.
This case highlights that diabetic ketoacidosis can cause non-occlusive HI, possibly presenting as nodular lesions indistinguishable from neoplasms. |
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Bibliography: | Author contributions: Barros LCTR and Santos BMRT designed the report; Gomes VMS and Ferreira GSA collected the patient’s clinical data, analyzed the data and wrote the paper; Barros LCTR, Santos BMRT and Vieira LPB reviewed the paper. Corresponding author: Gustavo de Sousa Arantes Ferreira, MD, MSc, Surgeon, Teacher, Liver Transplantation, Instituto de Cardiologia do Distrito Federal, Setor Sudoeste, S/N, Brasilia 70673900, Distrito Federal, Brazil. gustferr@ufmg.br |
ISSN: | 1948-5182 1948-5182 |
DOI: | 10.4254/wjh.v14.i11.1977 |