scholarly journals A case of cryptogenic pseudocirrhosis causing acute liver failure: when clinic and radiology work together

2019 ◽  
Vol 13 (2) ◽  
pp. 121-123
Author(s):  
Martina Finocchi ◽  
Ombretta Para ◽  
Giacomo Zaccagnini ◽  
Lorenzo Corbo ◽  
Lucia Maddaluni ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Systemic Chemotherapy ◽  
Acute Liver Injury ◽  
Metastatic Breast ◽  
International Normalized Ratio ◽  
Caudate Lobe ◽  
Oncologic Patients ◽  
Liver Changes

It is known that a wild spectrum of hepatic manifestations can be common presentations of metastatic breast cancer. Pseudocirrhosis pattern has been often described as almost always secondary to systemic chemotherapy and it is defined by morphological liver changes that mimic cirrhosis including capsular retraction, nodularity, parenchyma atrophy and caudate lobe, radiologically identifiable. Acute liver injury is an occasional complication in oncologic patients, and it outlines an organ failure when there is evidence of encephalopathy and coagulopathy (international normalized ratio >1.5) in the absence of pre-existing liver disease, with an illness of <26 weeks duration. The two most common etiologies are leukemia/lymphoma followed by breast cancer but also in this case, liver is involved almost always after chemotherapy, hormonotherapy or radiotherapy. Here we present a case of rapid evolving acute liver failure presented as cryptogenic pseudocirrhosis without any evidence of primitive breast cancer but an incidental demonstration.

scholarly journals S2706 Metastatic Breast Cancer Presenting as Acute Liver Failure

2020 ◽  
Vol 115 (1) ◽  
pp. S1416-S1416
Author(s):  
Cristina Calogero ◽  
Sanaa Arastu ◽  
Michael Grodsky ◽  
Manju Ambelil ◽  
Dina Halegoua-DeMarzio
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Metastatic Breast

scholarly journals Metastatic Breast Cancer Presenting as Acute Liver Failure

2020 ◽  
pp. 1-3
Author(s):  
Dina Halegoua-DeMarzio ◽  
Cristina Calogero ◽  
Sanaa Arastu ◽  
Dina Halegoua-DeMarzio
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Liver Biopsy ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Metastatic Breast ◽  
Abdominal Ultrasound ◽  
Metastatic Carcinoma ◽  
Clinical Syndrome ◽  
Unknown Etiology

Acute liver failure (ALF) is a rare clinical syndrome, with up to 20% of cases having no known etiology. Of the many causes, initial presentation of metastatic carcinoma is rare, with malignant infiltration of the liver usually diagnosed postmortem. We present a case of fulminant liver failure caused by a new diagnosis of metastatic breast cancer. A 55-year-old female with no significant medical history presented with fatigue and jaundice for one month and one week of pruritus and lower extremity edema. On presentation, she had a MELD-Na of 38 with confusion, therefore prompting rapid liver transplant evaluation. An abdominal ultrasound revealed cirrhotic morphology of the liver, ascites, and marked hepatic echogenicity. An abdominal MRI needed for listing revealed an enlarged liver that was replaced by innumerable ringenhancing lesions concerning for metastasis. A liver biopsy was performed and revealed metastatic carcinoma consistent with breast primary with no underlying cirrhosis. Transplant workup was terminated, and the patient was referred to Oncology and Palliative Care for further management. We report a clinical lesson regarding the importance of confirming prior liver disease prior to transplant listing. Rare presentations such as this argue towards liver biopsy prior to listing ALF patients of unknown etiology.

scholarly journals Acute Liver Failure Secondary to Metastatic Breast Cancer in a Patient with Ulcerative Colitis

2021 ◽  
pp. 85-89
Author(s):  
Luisa Leite Barros ◽  
Bianca Pocopetz Facas ◽  
Camila Cunha Gonzaga Lima ◽  
Paula Emília Rivas Farez ◽  
Alberto Queiroz Farias
Keyword(s):  
Breast Cancer ◽  
Ulcerative Colitis ◽  
Metastatic Breast Cancer ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Metastatic Breast

scholarly journals Tc-99m GSA scintigraphy within the first 3 days after admission as an early predictor of outcome in severe acute liver injury

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yuji Suzuki ◽  
Keisuke Kakisaka ◽  
Takuro Sato ◽  
Ryouichi Mikami ◽  
Hiroaki Abe ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Injury ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Acute Liver Injury ◽  
Area Under The Curve ◽  
Region Of Interest ◽  
Free Survival ◽  
Risk Of Death ◽  
Poor Outcome

AbstractPatients with severe acute liver injury (SLI) usually recover spontaneously. However, some SLI patients progress to acute liver failure with varying degrees of hepatic encephalopathy. Acute liver failure is associated with high mortality and can be substantially reduced by liver transplantation. Therefore, distinguishing SLI patients who might progress to acute liver failure and are at a risk of death is important when evaluating patients needing liver transplantation. The present study aimed to determine whether technetium-99m-diethylenetriaminepentaacetic acid galactosyl human serum albumin (Tc-99m GSA) scintigraphy can predict the prognosis of patients with SLI. This prospective observational study included 69 SLI patients. The accuracy of Tc-99m GSA for predicting death or liver transplantation for 6 months was assessed. Between the two groups of patients stratified based on the cut-off values from the receiver operating characteristic curves, 6-month transplant-free survival was compared. Sixteen (23.2%) patients died or underwent liver transplantation from admission (poor outcome). The hepatic accumulation index was calculated by dividing the radioactivity of the liver region of interest by that of the liver-plus-heart region of interest at 15 min (i.e., LHL15). The LHL15 in the 16 patients (0.686) was significantly lower than that in survivors (0.836; P < 0.0001). The optimal LHL15 cut-off for distinguishing poor outcome and survival was 0.737 with a sensitivity of 81.3%, specificity of 88.7%, and area under the curve of 0.907 (95% CI, 0.832–0.981). When patients were divided into two groups based on the LHL15 cut-off value, the 6-month transplant-free survival was significantly lower in patients with an LHL15 level ≤ 0.737. Tc-99m GSA scintigraphy may help predict the prognosis of patients with SLI.

Hepatoprotective effects of ginsenoside Rk3 in acetaminophen-induced liver injury in mice by activation of autophagy

2021 ◽  
Author(s):  
Linlin Qu ◽  
Rongzhan Fu ◽  
xiaoxuan Ma ◽  
Daidi Fan
Keyword(s):  
Liver Injury ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Acute Liver Injury ◽  
Common Causes ◽  
Hepatoprotective Effects

Acetaminophen (APAP)-induced acute liver injury (AIALI) is one of the most common causes of acute liver failure. Owing to the limitations of N-acetylcysteine (NAC), which is the only antidote currently...

scholarly journals Hemostatic Balance in Pediatric Acute Liver Failure: Epidemiology of Bleeding and Thrombosis, Physiology, and Current Strategies

2020 ◽  
Vol 8 ◽  
Author(s):  
Yonca Bulut ◽  
Anil Sapru ◽  
Gavin D. Roach
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Cell Activation ◽  
Protein S ◽  
Bleeding Risk ◽  
International Normalized Ratio ◽  
Clinical Syndrome ◽  
Low Grade ◽  
Endothelial Cell Activation ◽  
Pediatric Acute Liver Failure

Pediatric Acute Liver Failure (PALF) is a rapidly progressive clinical syndrome encountered in the pediatric ICU which may rapidly progress to multi-organ dysfunction, and on occasion to life threatening cerebral edema and hemorrhage. Pediatric Acute Liver Failure is defined as severe acute hepatic dysfunction accompanied by encephalopathy and liver-based coagulopathy defined as prolongation of International Normalized Ratio (INR) &gt;1.5. However, coagulopathy in PALF is complex and warrants a deeper understanding of the hemostatic balance in acute liver failure. Although an INR value of &gt;1.5 is accepted as the evidence of coagulopathy and has historically been viewed as a prognostic factor of PALF, it may not accurately reflect the bleeding risk in PALF since it only measures procoagulant factors. Paradoxically, despite the prolongation of INR, bleeding risk is lower than expected (around 5%). This is due to “rebalanced hemostasis” due to concurrent changes in procoagulant, anticoagulant and fibrinolytic systems. Since the liver is involved in both procoagulant (Factors II, V, IX, XI, and fibrinogen) and anticoagulant (Protein C, Protein S, and antithrombin) protein synthesis, PALF results in “rebalanced hemostasis” or even may shift toward a hypercoagulable state. In addition to rebalanced coagulation there is altered platelet production due to decreased thrombopoietin production by liver, increased von Willebrand factor from low grade endothelial cell activation, and hyperfibrinolysis and dysfibrinogenemia from altered synthetic liver dysfunction. All these alterations contribute to the multifactorial nature of coagulopathy in PALF. Over exuberant use of prophylactic blood products in patients with PALF may contribute to morbidities such as fluid overload, transfusion-associated lung injury, and increased thrombosis risk. It is essential to use caution when using INR values for plasma and factor administration. In this review we will summarize the complexity of coagulation in PALF, explore “rebalanced hemostasis,” and discuss the limitations of current coagulation tests. We will also review strategies to accurately diagnose the coagulopathy of PALF and targeted therapies.

scholarly journals Acute Liver Failure with Diffuse Liver Metastasis from Breast Cancer, Not Detected by Computed Tomography: 2 Case Reports

2018 ◽  
Vol 11 (3) ◽  
pp. 699-704 ◽  
Author(s):  
Takatsugu Ogata ◽  
Yuichiro Kikawa ◽  
Misato Ogata ◽  
Hironaga Satake ◽  
Yukimasa Hatachi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Computed Tomography ◽  
Liver Metastasis ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Hepatic Failure ◽  
Poor Prognosis ◽  
Alcoholic Hepatitis ◽  
Case Reports ◽  
History Of

Diffuse liver metastasis is a rare pattern of liver metastasis that is associated with hepatic failure and poor prognosis. We experienced 2 cases of acute liver failure due to diffuse metastasis that could not be detected using computed tomography. In case 1, it was difficult to differentiate diffuse metastasis from alcoholic hepatitis. In case 2, it was difficult to diagnose diffuse liver metastasis because the patient had no history of malignancy. When liver enzyme levels are elevated, it is necessary to consider liver metastasis as a potential cause, regardless of computed tomography findings.

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