Extensive hepatic infarction in severe preeclampsia as part of the HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): Evolution of CT findings and successful treatment with plasma exchange therapy
Objective: We describe the serial computed tomography (CT) findings of extensive hepatic infarction and successful plasma exchange therapy in a severe preeclamptic woman with postpartum HELLP syndrome. Case Report: A 38 year-old woman presented with elevated blood pressure of 140–180/90–120 mmHg and...
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| Format: | Article |
| Language: | English |
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Elsevier
2012-09-01
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| Series: | Taiwanese Journal of Obstetrics & Gynecology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1028455912001325 |
| _version_ | 1828176229036982272 |
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| author | Min-Min Chou Ya-Fang Chen Hsiao-Fan Kung Chih-Ku Liu Lou Sun Wei-Chi Chen Jeng-Jhy Tseng Bor-Jen Lee |
| author_facet | Min-Min Chou Ya-Fang Chen Hsiao-Fan Kung Chih-Ku Liu Lou Sun Wei-Chi Chen Jeng-Jhy Tseng Bor-Jen Lee |
| author_sort | Min-Min Chou |
| collection | DOAJ |
| description | Objective: We describe the serial computed tomography (CT) findings of extensive hepatic infarction and successful plasma exchange therapy in a severe preeclamptic woman with postpartum HELLP syndrome.
Case Report: A 38 year-old woman presented with elevated blood pressure of 140–180/90–120 mmHg and 3+ proteinuria at 28 weeks of gestation. Two days after admission, the patient suddenly complained of severe epigastric pain and headache. Her blood pressure rose sharply to 195/120 mmHg. A 980 g female was delivered by emergency cesarean section. Following delivery, the patient's clinical condition and laboratory values deteriorated, with progressive liver insufficiency (peak AST level = 4246 IU/L, ALT = 3685 IU/L, LDH = 6237 IU/L, platelets = 72,000/mm3). Two consecutive plasma exchanges (PEX) were undertaken on the 3rd and 4th postpartum day. A contrast-enhanced CT of the abdomen performed 8 days postpartum showed geographically wedge-shaped areas of low attenuation, with a mottled appearance in the right hepatic lobe. Shortly thereafter, the patient recovered and all laboratory parameters gradually normalized 3 weeks after delivery. Follow-up CT-scan of the liver 2 months postpartum showed no evidence of infarction, with complete recovery.
Conclusion: We recommend that severely ill patients with HELLP syndrome having epigastric pain should undergo CT imaging of the liver. A trial of postpartum PEX therapy should be considered for treatment of the HELLP syndrome complicated with hepatic infarction, which is recalcitrant to conventional medical management, and fails to abate within 72–96 hours of delivery. |
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| format | Article |
| id | doaj.art-6289f742f1b747b4b68249f005ad9186 |
| institution | Directory Open Access Journal |
| issn | 1028-4559 |
| language | English |
| last_indexed | 2024-04-12T04:40:07Z |
| publishDate | 2012-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Taiwanese Journal of Obstetrics & Gynecology |
| spelling | doaj.art-6289f742f1b747b4b68249f005ad91862022-12-22T03:47:40ZengElsevierTaiwanese Journal of Obstetrics & Gynecology1028-45592012-09-0151341842010.1016/j.tjog.2012.07.018Extensive hepatic infarction in severe preeclampsia as part of the HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): Evolution of CT findings and successful treatment with plasma exchange therapyMin-Min Chou0Ya-Fang Chen1Hsiao-Fan Kung2Chih-Ku Liu3Lou Sun4Wei-Chi Chen5Jeng-Jhy Tseng6Bor-Jen Lee7Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, TaiwanDepartment of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, TaiwanDepartment of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, TaiwanDepartment of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, TaiwanDepartment of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, TaiwanDepartment of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, TaiwanDepartment of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, TaiwanDepartment of Medicine, Taichung Veterans General Hospital, Taichung, TaiwanObjective: We describe the serial computed tomography (CT) findings of extensive hepatic infarction and successful plasma exchange therapy in a severe preeclamptic woman with postpartum HELLP syndrome. Case Report: A 38 year-old woman presented with elevated blood pressure of 140–180/90–120 mmHg and 3+ proteinuria at 28 weeks of gestation. Two days after admission, the patient suddenly complained of severe epigastric pain and headache. Her blood pressure rose sharply to 195/120 mmHg. A 980 g female was delivered by emergency cesarean section. Following delivery, the patient's clinical condition and laboratory values deteriorated, with progressive liver insufficiency (peak AST level = 4246 IU/L, ALT = 3685 IU/L, LDH = 6237 IU/L, platelets = 72,000/mm3). Two consecutive plasma exchanges (PEX) were undertaken on the 3rd and 4th postpartum day. A contrast-enhanced CT of the abdomen performed 8 days postpartum showed geographically wedge-shaped areas of low attenuation, with a mottled appearance in the right hepatic lobe. Shortly thereafter, the patient recovered and all laboratory parameters gradually normalized 3 weeks after delivery. Follow-up CT-scan of the liver 2 months postpartum showed no evidence of infarction, with complete recovery. Conclusion: We recommend that severely ill patients with HELLP syndrome having epigastric pain should undergo CT imaging of the liver. A trial of postpartum PEX therapy should be considered for treatment of the HELLP syndrome complicated with hepatic infarction, which is recalcitrant to conventional medical management, and fails to abate within 72–96 hours of delivery.http://www.sciencedirect.com/science/article/pii/S1028455912001325computed tomographyHELLP syndromehepatic infarctionplasma exchangepreeclampsia |
| spellingShingle | Min-Min Chou Ya-Fang Chen Hsiao-Fan Kung Chih-Ku Liu Lou Sun Wei-Chi Chen Jeng-Jhy Tseng Bor-Jen Lee Extensive hepatic infarction in severe preeclampsia as part of the HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): Evolution of CT findings and successful treatment with plasma exchange therapy Taiwanese Journal of Obstetrics & Gynecology computed tomography HELLP syndrome hepatic infarction plasma exchange preeclampsia |
| title | Extensive hepatic infarction in severe preeclampsia as part of the HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): Evolution of CT findings and successful treatment with plasma exchange therapy |
| title_full | Extensive hepatic infarction in severe preeclampsia as part of the HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): Evolution of CT findings and successful treatment with plasma exchange therapy |
| title_fullStr | Extensive hepatic infarction in severe preeclampsia as part of the HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): Evolution of CT findings and successful treatment with plasma exchange therapy |
| title_full_unstemmed | Extensive hepatic infarction in severe preeclampsia as part of the HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): Evolution of CT findings and successful treatment with plasma exchange therapy |
| title_short | Extensive hepatic infarction in severe preeclampsia as part of the HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): Evolution of CT findings and successful treatment with plasma exchange therapy |
| title_sort | extensive hepatic infarction in severe preeclampsia as part of the hellp syndrome hemolysis elevated liver enzymes and low platelets evolution of ct findings and successful treatment with plasma exchange therapy |
| topic | computed tomography HELLP syndrome hepatic infarction plasma exchange preeclampsia |
| url | http://www.sciencedirect.com/science/article/pii/S1028455912001325 |
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