Angiographic demonstration of non-occlusive hepatic infarction with scintigraphic and microscopic correlation

Abstract

The angiographic appearances of histologically proven hepatic infarction without vascular occlusion has not, to our knowledge, been previously described. A case of non-occlusive hepatic infarction in a diabetic patient is presented and correlated with scintigraphic and microscopic findings. It would appear to be the first recorded case of hepatic infarction associated with diabetic ketoacidosis. A follow-up angiogram showed resolution. The literature is briefly reviewed.

Multiple hepatic infarctions secondary to diabetic ketoacidosis: A case report

“…Common causes are portal vein thrombosis, hepatic artery thrombosis, trauma, pancreatitis, surgery (liver transplantation in particular), or hilarious neoplasms[ 1 , 3 - 5 ]. However, non-occlusive HI may rarely occur[ 3 , 4 , 6 ]. These uncommon events are associated with disruption of the liver microvasculature and can be secondary to rheumatologic diseases (polyarteritis nodosa, scleroderma, systemic lupus erythematosus, Churg-Strauss syndrome), infection, polycythemia vera, hemodynamic shock, and severe preeclampsia, among other causes[ 6 ].…”

“…Diabetic ketoacidosis (DK) has been described as a potential cause of non-occlusive HI in a limited number of cases reported in the medical literature[ 3 , 6 - 8 ]. The pathophysiology of HI in patients with DK is not completely understood but is thought to be multifactorial.…”

“…Dehydration and hypotension often present in DK decrease blood flow to the liver, further contributing to ischemia[ 3 ]. The low levels of 2, 3-diphosphoglycerate in patients with DK may affect hepatocyte oxygenation, and widespread atherosclerosis, endothelial dysfunction, and hypercoagulability–that are commonly found in patients with diabetes–can also play a role in the occurrence of HI[ 3 , 6 , 7 ]. Abdominal pain, nausea, jaundice, and fever are the most common symptoms of HI[ 3 , 6 ].…”

“…The low levels of 2, 3-diphosphoglycerate in patients with DK may affect hepatocyte oxygenation, and widespread atherosclerosis, endothelial dysfunction, and hypercoagulability–that are commonly found in patients with diabetes–can also play a role in the occurrence of HI[ 3 , 6 , 7 ]. Abdominal pain, nausea, jaundice, and fever are the most common symptoms of HI[ 3 , 6 ]. Transaminase levels are elevated, and hyperbilirubinemia, leukocytosis, and disorders of hemostasis are also frequent findings in HI[ 3 , 6 , 8 ].…”

Triad: diabetic ketoacidosis, elevated liver enzymes and abdominal pain— think liver infarct!

“…The first case of hepatic infarction associated with DKA, diagnosed with angiogram, isotope liver scan, and biopsy, was apparently reported in 1977 6 and 1978. 7 In 1990, further cases of hepatic infarction were reported in diabetic patients. 1,8,9 Although varied, presenting symptoms largely included abdominal pain and elevated serum transaminases.…”