Zahn's `infarcts' of the liver

Abstract

SYNOPSIS Three patients were found at necropsy to have Zahn's 'infarcts' of the liver. In one of these cases the 'infarct' merely showed severe centrilobular congestion. In the other two cases there was centrilobular necrosis, and in one of these early fibrosis was seen. Portal vein occlusion was present in all three cases and this had followed splenectomy in two of them. Necropsy was performed six hours after death. There was an early mediastinitis and bronchopneumonic consolidation of the right lower lobe. Other significant findings were confined to the liver and portal venous system. Externally the liver was generally pale but showed several large, dark red, sharply defined areas. On section these had the typical 'nutmeg' appearance normally associated with chronic venous congestion. In such areas, many large intrahepatic branches of the portal vein were occluded by thrombus. The splenic vein was also filled by thrombus which extended from the ligated splenic pedicle to the origin of the portal vein. No obstruction of the extrahepatic part of the portal vein was present and there was no abnormality of the hepatic artery or veins.Microscopy ofliver The pale areas in the liver showed considerable fatty change. In the dark red areas there was Received for publication 22 March 1966 generalized congestion of the sinusoids, most prominent in the centrilobular zones (Fig. 1). Liver parenchymal cells in the congested areas were shrunken and contained small amounts of lipofuscin pigment (Fig. 2). Several branches of the portal vein were occluded by organizing thrombus. The portal tracts were otherwise normal.CASE 2 A 70-year-old woman was seen during the following month complaining of constant epigastric pain of three weeks' duration. She was found to have an epigastric mass and a barium meal demonstrated a gastric carcinoma. A total gastric resection with oesophago-jejunostomy and splenectomy was carried out. Progress thereafter was at first good but 18 hours before death she became hypotensive and had signs suggesting peritonitis. She died on the sixth post-operative day.At necropsy 36 hours after death localized peritonitis due to failure of the anastomosis was present. There was haemorrhage into the left adrenal gland. The remaining abnormalities were limited to the liver and portal venous system. The liver showed lesions similar to those described in case 1, but on section there was also thrombus in the larger branches of the portal vein supplying these areas. The splenic vein was filled by thrombus to its junction with the superior mesenteric vein. No lesions were found in the hepatic artery or veins.

A Case of Primary Hepatic Tumor Causing Segmental Changes on Imaging and Its Relation to Zahn's Infarct.

“…We found only four in the literature (Horrocks and Tapp, 1966;Haratake et al 1987;Tsuuchi et al 1990;Matsumoto et al 1992). However, cases showing segmental change on imaging, as in this case, were reported first by Inamoto et al (1981) and Nishikawa et al (1981), and later by Matsui et al (1984), Takayasu et al (1986), and Itai et al (1988).…”

“…In 1897, Zahn described hepatocellular atrophy and congestion of the sinusoid due to obstruction of intrahepatic portal vein (Horrocks and Tapp, 1966). This pathological change does not accompany necrosis, and is now called Zahn's infarct (Cotran et al 1989;Craig, 1990).…”

Comments and illustrations of the WFUMB CEUS liver guidelines: Rare vascular pathology, part II

“…Usually, a reduction in portal venous blood flow is compensated by increased arterialization which does not occur in these cases. Other causative factors may include a reduction in arterial perfusion (although the hepatic artery is intact), arterial hypotension and existing venous congestion with disrupted venous outflow can occur [71,72]. Such well-defined hyperemic areas in the liver were first described by Zahn in 1897 (Zahn, F.W.…”

A posztoperatív keringésváltozások jelentősége a májsebészetben

“…Ennek ellenére necrosis nélküli szöveti elváltozás képében jelenik meg, miután az artériás perfúzió megléte és megnyíló kollaterálisok miatt nem beszélhetünk komplett anoxiáról, mint azt klasszikus infarktusok esetében lát-juk. Az elváltozás hegesedéssel gyógyul [5,6]. A vena portae krónikus okklúziója mind fejlődési rendellenessé-gek, mind tumoros progresszió eredménye lehet, ugyanakkor az utóbbi időben a vena portae szelektív elzárása, mint terápiás lehetőség a többlépcsős májreszekciók algoritmusában a funkcionális kapacitás növelésének (máj-regeneráció-indukció) tárházát nyitotta meg [7].…”