{"title":"肝梗塞:非移植医学尸检中发现的不常见血管并发症的不常见原因","authors":"Dipanwita Biswas , Suvradeep Mitra , Ritambhra Nada , Ashish Bhalla , Saroj K. Sinha , Vanita Suri , Ajay Duseja","doi":"10.1016/j.jceh.2025.102533","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and aims</h3><div>Hepatic infarcts are uncommon vascular lesions due to dual vascular supply of the liver characterized by the peripherally-located wedge-shaped large zones of necrosis in the hepatic parenchyma. They are commonly seen as a complication of liver transplant.</div></div><div><h3>Material and methods</h3><div>The cases of hepatic infarcts of the native liver detected in medical autopsies were searched in the archives and their clinical, biochemical, gross, and histomorphological details were retrieved.</div></div><div><h3>Results</h3><div>Three cases of hepatic infarct of the native liver were detected from among 1865 consecutive cases of adult and pediatric autopsies (0.2%). These cases were caused by hornet stings, acute pancreatitis, and hemolysis, elevated liver enzymes, low platelet syndrome (HELLP) in a 24-year-old male, 19-year-old male, and a 28-year-old postpartum female, respectively. The first two cases showed 50–150 times elevated transaminases and conjugated hyperbilirubinemia. All cases showed hyperemic to pale subcapsular infarcts. The HELLP syndrome case showed intrasinusoidal fibrin-rich microthrombi, while the other two cases showed the presence of fibrin-rich/organized microthrombi involving variable-sized portal and central venous radicles. Two of these cases (hornet sting and HELLP syndrome) did not show any macroscopic thrombi in the portal vein, hepatic artery, or hepatic veins.</div></div><div><h3>Conclusion</h3><div>Hepatic infarcts are rare vascular lesions found in the nontransplant liver. The gross and histomorphology of these lesions depend on the age of these lesions. They can occur in the presence of vascular microthrombi in the absence of any documented macroscopic thrombus.</div></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":"15 4","pages":"Article 102533"},"PeriodicalIF":3.3000,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Hepatic Infarct: Uncommon Causes of an Uncommon Vascular Complication Revealed at Nontransplant Medical Autopsies\",\"authors\":\"Dipanwita Biswas , Suvradeep Mitra , Ritambhra Nada , Ashish Bhalla , Saroj K. Sinha , Vanita Suri , Ajay Duseja\",\"doi\":\"10.1016/j.jceh.2025.102533\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background and aims</h3><div>Hepatic infarcts are uncommon vascular lesions due to dual vascular supply of the liver characterized by the peripherally-located wedge-shaped large zones of necrosis in the hepatic parenchyma. They are commonly seen as a complication of liver transplant.</div></div><div><h3>Material and methods</h3><div>The cases of hepatic infarcts of the native liver detected in medical autopsies were searched in the archives and their clinical, biochemical, gross, and histomorphological details were retrieved.</div></div><div><h3>Results</h3><div>Three cases of hepatic infarct of the native liver were detected from among 1865 consecutive cases of adult and pediatric autopsies (0.2%). These cases were caused by hornet stings, acute pancreatitis, and hemolysis, elevated liver enzymes, low platelet syndrome (HELLP) in a 24-year-old male, 19-year-old male, and a 28-year-old postpartum female, respectively. The first two cases showed 50–150 times elevated transaminases and conjugated hyperbilirubinemia. All cases showed hyperemic to pale subcapsular infarcts. The HELLP syndrome case showed intrasinusoidal fibrin-rich microthrombi, while the other two cases showed the presence of fibrin-rich/organized microthrombi involving variable-sized portal and central venous radicles. Two of these cases (hornet sting and HELLP syndrome) did not show any macroscopic thrombi in the portal vein, hepatic artery, or hepatic veins.</div></div><div><h3>Conclusion</h3><div>Hepatic infarcts are rare vascular lesions found in the nontransplant liver. The gross and histomorphology of these lesions depend on the age of these lesions. They can occur in the presence of vascular microthrombi in the absence of any documented macroscopic thrombus.</div></div>\",\"PeriodicalId\":15479,\"journal\":{\"name\":\"Journal of Clinical and Experimental Hepatology\",\"volume\":\"15 4\",\"pages\":\"Article 102533\"},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2025-02-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical and Experimental Hepatology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0973688325000337\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical and Experimental Hepatology","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0973688325000337","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Hepatic Infarct: Uncommon Causes of an Uncommon Vascular Complication Revealed at Nontransplant Medical Autopsies
Background and aims
Hepatic infarcts are uncommon vascular lesions due to dual vascular supply of the liver characterized by the peripherally-located wedge-shaped large zones of necrosis in the hepatic parenchyma. They are commonly seen as a complication of liver transplant.
Material and methods
The cases of hepatic infarcts of the native liver detected in medical autopsies were searched in the archives and their clinical, biochemical, gross, and histomorphological details were retrieved.
Results
Three cases of hepatic infarct of the native liver were detected from among 1865 consecutive cases of adult and pediatric autopsies (0.2%). These cases were caused by hornet stings, acute pancreatitis, and hemolysis, elevated liver enzymes, low platelet syndrome (HELLP) in a 24-year-old male, 19-year-old male, and a 28-year-old postpartum female, respectively. The first two cases showed 50–150 times elevated transaminases and conjugated hyperbilirubinemia. All cases showed hyperemic to pale subcapsular infarcts. The HELLP syndrome case showed intrasinusoidal fibrin-rich microthrombi, while the other two cases showed the presence of fibrin-rich/organized microthrombi involving variable-sized portal and central venous radicles. Two of these cases (hornet sting and HELLP syndrome) did not show any macroscopic thrombi in the portal vein, hepatic artery, or hepatic veins.
Conclusion
Hepatic infarcts are rare vascular lesions found in the nontransplant liver. The gross and histomorphology of these lesions depend on the age of these lesions. They can occur in the presence of vascular microthrombi in the absence of any documented macroscopic thrombus.