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Peliosis hepatis with hemorrhagic necrosis and rupture: a case report with emphasis on the multi-detector CT findings.

Kim EA, Yoon KH, Jeon SJ, Cai QY, Lee YW, Yoon SE, Yoon KJ, Juhng SK - Korean J Radiol (2007 Jan-Feb)

Bottom Line: We report here on an uncommon case of peliosis hepatis with hemorrhagic necrosis that was complicated by massive intrahepatic bleeding and rupture, and treated by emergent right lobectomy.We demonstrate the imaging findings, with emphasis on the triphasic, contrast-enhanced multidetector CT findings, as well as reporting the clinical outcome in a case of peliosis hepatis with fatal hemorrhage.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Wonkwang University School of Medicine, Jeonbuk 570-711, Korea.

ABSTRACT
We report here on an uncommon case of peliosis hepatis with hemorrhagic necrosis that was complicated by massive intrahepatic bleeding and rupture, and treated by emergent right lobectomy. We demonstrate the imaging findings, with emphasis on the triphasic, contrast-enhanced multidetector CT findings, as well as reporting the clinical outcome in a case of peliosis hepatis with fatal hemorrhage.

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Related in: MedlinePlus

The unenhanced CT scan shows massive acute hematoma in the right subcapsular area (A, arrows). The triphasic, contrast-enhanced CT scan shows small enhancing focus (arrow) on the background of hemorrhage, which is isodense to liver parenchyma on the arterial (B), portal (C) and delayed (D) phases. Note a small lesion in the right lobe (arrowhead) that is hypodense on the arterial phase (B), peripherally enhanced on the portal venous phase (C), and it becomes totally isodense or slightly hyperdense on the delayed phase (D).
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Figure 3: The unenhanced CT scan shows massive acute hematoma in the right subcapsular area (A, arrows). The triphasic, contrast-enhanced CT scan shows small enhancing focus (arrow) on the background of hemorrhage, which is isodense to liver parenchyma on the arterial (B), portal (C) and delayed (D) phases. Note a small lesion in the right lobe (arrowhead) that is hypodense on the arterial phase (B), peripherally enhanced on the portal venous phase (C), and it becomes totally isodense or slightly hyperdense on the delayed phase (D).

Mentions: On the unenhanced images, about a 9 cm-sized, low density, irregular-shaped lesion was seen at the right hepatic dome. Most of the lesion was not enhanced, but multiple, irregular and linear, septa-like densities were demonstrated which were of isoattenuation to the adjacent normal parenchyma on all phases (Fig. 2). The unenhanced images also revealed a huge, heterogeneous and mainly hyperdense lesion occupying the entire right subcapsular area, and this was suggestive of acute hematoma (Fig. 3A). On the contrast-enhanced triphasic images, most of the lesion was not enhanced, except for multiple small enhancing foci that were gradually enlarged and isodense on all phases as compared with the liver parenchyma. The margin of the lesion at the junction with the normal parenchyma was shaggy and irregular. Another 1 cm-sized lesion was seen at the right hepatic lobe, and the lesion was of low density on the arterial phase; it showed peripheral isodense enhancement on the portal venous phase and it became totally isodense or slightly hyperdense on the delayed phase (Fig. 3). The MPR images helped us view all the above-mentioned findings at a glance (Fig. 4).


Peliosis hepatis with hemorrhagic necrosis and rupture: a case report with emphasis on the multi-detector CT findings.

Kim EA, Yoon KH, Jeon SJ, Cai QY, Lee YW, Yoon SE, Yoon KJ, Juhng SK - Korean J Radiol (2007 Jan-Feb)

The unenhanced CT scan shows massive acute hematoma in the right subcapsular area (A, arrows). The triphasic, contrast-enhanced CT scan shows small enhancing focus (arrow) on the background of hemorrhage, which is isodense to liver parenchyma on the arterial (B), portal (C) and delayed (D) phases. Note a small lesion in the right lobe (arrowhead) that is hypodense on the arterial phase (B), peripherally enhanced on the portal venous phase (C), and it becomes totally isodense or slightly hyperdense on the delayed phase (D).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2626703&req=5

Figure 3: The unenhanced CT scan shows massive acute hematoma in the right subcapsular area (A, arrows). The triphasic, contrast-enhanced CT scan shows small enhancing focus (arrow) on the background of hemorrhage, which is isodense to liver parenchyma on the arterial (B), portal (C) and delayed (D) phases. Note a small lesion in the right lobe (arrowhead) that is hypodense on the arterial phase (B), peripherally enhanced on the portal venous phase (C), and it becomes totally isodense or slightly hyperdense on the delayed phase (D).
Mentions: On the unenhanced images, about a 9 cm-sized, low density, irregular-shaped lesion was seen at the right hepatic dome. Most of the lesion was not enhanced, but multiple, irregular and linear, septa-like densities were demonstrated which were of isoattenuation to the adjacent normal parenchyma on all phases (Fig. 2). The unenhanced images also revealed a huge, heterogeneous and mainly hyperdense lesion occupying the entire right subcapsular area, and this was suggestive of acute hematoma (Fig. 3A). On the contrast-enhanced triphasic images, most of the lesion was not enhanced, except for multiple small enhancing foci that were gradually enlarged and isodense on all phases as compared with the liver parenchyma. The margin of the lesion at the junction with the normal parenchyma was shaggy and irregular. Another 1 cm-sized lesion was seen at the right hepatic lobe, and the lesion was of low density on the arterial phase; it showed peripheral isodense enhancement on the portal venous phase and it became totally isodense or slightly hyperdense on the delayed phase (Fig. 3). The MPR images helped us view all the above-mentioned findings at a glance (Fig. 4).

Bottom Line: We report here on an uncommon case of peliosis hepatis with hemorrhagic necrosis that was complicated by massive intrahepatic bleeding and rupture, and treated by emergent right lobectomy.We demonstrate the imaging findings, with emphasis on the triphasic, contrast-enhanced multidetector CT findings, as well as reporting the clinical outcome in a case of peliosis hepatis with fatal hemorrhage.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Wonkwang University School of Medicine, Jeonbuk 570-711, Korea.

ABSTRACT
We report here on an uncommon case of peliosis hepatis with hemorrhagic necrosis that was complicated by massive intrahepatic bleeding and rupture, and treated by emergent right lobectomy. We demonstrate the imaging findings, with emphasis on the triphasic, contrast-enhanced multidetector CT findings, as well as reporting the clinical outcome in a case of peliosis hepatis with fatal hemorrhage.

Show MeSH
Related in: MedlinePlus