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Peliosis hepatis (PH) is a rare condition showing presence of multiple blood-filled cystic cavities in the liver. It does not have any gender predilection, and is suspected to be idiopathic. However, in patients with predisposing diseases, its prevalence can range from 0.2 to 22%. The association between PH and anemia has not been completely established. PH has been reported in a patients with hematologic disease, and also in patient with spherocytic haemolytic anemia. It is also suggested that acute sequestration of blood can happen in these sinusoidal cavities, which can lead to development of anemia and thrombocytopenia. We present a case of 40-year female who presented with abdominal pain and recurrent iron deficiency anemia. On examination, she was severely pale, and had moderate hepatosplenomegaly. Ultrasonography showed hepatomegaly and splenomegaly, and her blood investigations revealed severe iron deficiency with bone marrow showing hypercellular marrow with depleted iron stores. Upper gastrointestinal endoscopy was normal. Liver biopsy showed changes suggestive of peliosis hepatis. She was treated with iron andmultiple blood transfusions and is in good health 6 months post presentation. Also, the association between anemia and PH has not been established
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Objective@#To compare the MRI features of peliosis hepatis and hepatic metastases following chemotherapy for gastrointestinal adenocarcinoma with the aim to improve the differential diagnosis.@*Methods@#The clinical data of 33 patients with gastrointestinal adenocarcinoma treated from June 2014 to December 2017 at Zhongshan Hospital of Fudan University were retrospectively analyzed. Of the 26 males and 7 females aged (56.0±9.8) years, there were 11 patients with peliosis hepatis and 22 patients with hepatic metastases following chemotherapy in these patients. All patients underwent contrast-enhanced abdominal MRI scans. The differences in the MRI features, including morphology, margin, signal intensity on plain scanning and enhancement patterns were compared statistically. The apparent diffusion coefficient (ADC) values of peliosis hepatis, hepatic metastases and adjacent hepatic parenchyma were measured in an ADC map.@*Results@#In 14 lesions of the 11 patients with peliosis hepatis, 10 lesions were ill-defined and 4 lesions were well-defined. In 31 lesions of the 22 patients with hepatic metastases, 5 lesions were ill-defined and 26 lesions were well-defined. Significant differences existed between peliosis hepatis and hepatic metastases in the margin (P<0.05). The ADC value of hepatic metastases was significantly lower than that of peliosis hepatis and the adjacent hepatic parenchyma (P<0.05). In all the 14 lesions of peliosis hepatis, 10 lesions showed gradual filling enhancement, and 4 lesions showed marked and persistent enhancement. In all the 31 lesions of hepatic metastases, 28 lesions showed a ring-shaped enhancement, and 3 lesions showed "quick in and quick out" enhancement.@*Conclusions@#The lesions of peliosis hepatis following chemotherapy for gastrointestinal adenocarcinoma were ill-defined, with no restriction of water diffusion in the diffusion weighted imagings, and with progressive enhancement. The MRI manifestations of peliosis hepatis helped to differentiate peliosis hepatis from hepatic metastases of gastrointestinal adenocarcinoma.
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Objective To compare the MR] features of peliosis hepatis and hepatic metastases following chemotherapy for gastrointestinal adenocarcinoma with the aim to improve the differential diagnosis.Methods The clinical data of 33 patients with gastrointestinal adenocarcinoma treated from June 2014 to December 2017 at Zhongshan Hospital of Fudan University were retrospectively analyzed.Of the 26 males and 7 females aged (56.0 ± 9.8) years,there were 11 patients with peliosis hepatis and 22 patients with hepatic metastases following chemotherapy in these patients.All patients underwent contrast-enhanced abdominal MRI scans.The differences in the MRI features,including morphology,margin,signal intensity on plain scanning and enhancement patterns were compared statistically.The apparent diffusion coefficient (ADC) values of peliosis hepatis,hepatic metastases and adjacent hepatic parenchyma were measured in an ADC map.Results In 14 lesions of the 11 patients with peliosis hepatis,10 lesions were ill-defined and 4 lesions were well-defined.In 31 lesions of the 22 patients with hepatic metastases,5 lesions were ill-defined and 26 lesions were well-defined.Significant differences existed between peliosis hepatis and hepatic metastases in the margin (P ＜ 0.05).The ADC value of hepatic metastases was significantly lower than that of peliosis hepatis and the adjacent hepatic parenchyma (P ＜ 0.05).In all the 14 lesions of peliosis hepatis,10 lesions showed gradual filling enhancement,and 4 lesions showed marked and persistent enhancement.In all the 31 lesions of hepatic metastases,28 lesions showed a ring-shaped enhancement,and 3 lesions showed "quick in and quick out" enhancement.Conclusions The lesions of peliosis hepatis following chemotherapy for gastrointestinal adenocarcinoma were ill-defined,with no restriction of water diffusion in the diffusion weighted imagings,and with progressive enhancement.The MRI manifestations of peliosis hepatis helped to differentiate peliosis hepatis from hepatic metastases of gastrointestinal adenocarcinoma.
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Summary Peliosis hepatis is a rare benign disorder characterized by the presence of multiple cavities filled with blood with no preferential localization in the liver parenchyma. It may be related to several etiologic conditions, especially infections and toxicity of immunosuppressive drugs. To our knowledge, there are only three articles reporting the association between peliosis hepatis and systemic lupus erythematosus. In this report, we describe a case of this rare condition, highlighting the importance of magnetic resonance imaging. A short review of this subject is also presented.
Resumo Peliose hepática é uma patologia benigna rara caracterizada pela presença de múltiplas cavidades preenchidas por sangue sem localização preferencial no parênquima do fígado. Pode estar relacionada a uma série de condições etiológicas, dentre elas doenças infecciosas e toxicidade por drogas imunossupressoras. Para nosso conhecimento, existem apenas três artigos que abordam a associação entre peliose hepática e lúpus eritematoso sistêmico. Neste relato, descrevemos um caso desta rara condição, destacando a importância da ressonância magnética. Uma breve revisão sobre o tema é apresentada.
Subject(s)
Humans , Female , Peliosis Hepatis/etiology , Peliosis Hepatis/diagnostic imaging , Rare Diseases/diagnostic imaging , Lupus Erythematosus, Systemic/complications , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Middle AgedABSTRACT
Objective To investigate the MRI features of peliosis hepatis (PH).Methods Nine patients with pathologically proven PH were retrospectively included.Plain scan and contrast-enhanced MRI of the abdomen were performed on all patients before operation.All clinical,pathological and MR imaging data of patients were collected.The MR image analysis of the lesion included the number,location,size,shape,lesion margins,signal intensity,and enhancement pattern.Results Eleven lesions were detected in 9 patients,with 10 lesions in the right lobe of the liver and 1 lesion in the left lobe.The maximum diameter of the 11 lesions was 0.7 cm to 8.8 cm (mean 3.7 cm).All 11 lesions were round or oval in the shape.Seven lesions had clear boundaries and 4 lesions had blurred boundaries.Signal intensity of 2 lesions were homogeneous,while 9 lesions had heterogenous signal intensity on plain san.Ten lesions showed slightly hypointense on T1WI,slightly hyperintense on T2WI and mildly progressive enhancement.These lesions were weakly enhanced and showed slight cluster-like mild enhancement in the arterial phase.The enhancement scope of the lesions gradually filled into the interior in the portal vein phase and the signal intensity was slightly higher than liver in delay phase.One lesion showed hypointense on T1WI and hyperintensity on T2WI.After the enhancement,the lesion was evenly enhanced and showed continuous enhancement.On DWI,11 lesions were slightly hyperintense.The signal intensity of 9 lesions were equal to that of the liver,and the signal intensity of the 2 lesions was slightly higher than that of the liver on the ADC map.Conclusion MRI signs of PH have certain characteristics,which can help diagnosis and differential diagnosis.
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Se presenta el caso de una paciente mujer de 73 años que acude por disnea progresiva, fiebre diurna, hiporexia y cefalea de diez días de evolución. Antecedente de neoplasia ovarica, gastritis crónica y tromboembolia pulmonar. La fiebre continuó a pesar de tratamiento antibiótico convencional. Al examen, se identificó compromiso pulmonar y adenopatías inguinales, estas últimas corroboradas por ecografía de partes blandas. Los cultivos realizados fueron negativos y el estudio radiológico mostró compromiso pleuroparenquimal en base de pulmón izquierdo. La tomogragía abdominal evidenció hepatoesplenomegalia con hipodensidades múltiples (peliosis); la serología fue compatible con Bartonella henselae. La paciente evolucionó favorablemente luego de 72 horas de iniciado en tratamiento con doxiciclina a 100 mg cada doce horas.
This is the case of a 73-year-old female patient who presented with progressive dyspnea, diurnal fever, hyporexia and headache lasting for 10 days. She had a past medical history of an ovarian neoplasia, chronic gastritis and pulmonary thromboembolism. Fever continued despite conventional antibiotic treatment. Her physical examination revealed pulmonary involvement and bilateral inguinal adenopathy; the latter was corroborated with soft tissue ultrasound. Cultures performed were reported as negative and a chest X-ray film showed pleuro-parenchymal involvement in the left pulmonary base. An abdominal CT scan showed hepatosplenomegaly with multiple hypodense images (peliosis); and serological studies were compatible with Bartonella henselae. Doxyciclin 100 mg every 12 hours was started, and the patient started recovering uneventfully 72 hours after therapy was instituted.
Subject(s)
Humans , Female , Aged , Bartonella henselae , Cat-Scratch Disease , Fever , Bartonella Infections , Peliosis HepatisABSTRACT
Peliosis hepatis is a rare benign hepatic vascular disease.There is the lack of specific clinical features and preoperative diagnosis.A patient with intermittent liver area pain was admitted to the Third Central Hospital of Tianjin in April 2014.The patient with space-occupying lessions of the right lobe of liver was preliminarily diagnosed as with hepatocellular tumor or vasogenic tumor by computed tomography and B ultrasound examinations and then received liver resection combined with cholecystectomy.The result of postoperative pathological examination confirmed peliosis hepatis with adenomatous hyperplasia of liver cells.The patient was followed up till October 20,2014 without recurrence.
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Peliosis hepatis is a rare condition that can cause hepatic hemorrhage, rupture, and ultimately liver failure. Several authors have reported that peliosis hepatis develops in association with chronic wasting disease or prolonged use of anabolic steroids or oral contraceptives. In this report we describe a case in which discontinuation of steroid therapy improved the condition of a patient with peliosis hepatis. Our patient was a 64-year-old woman with a history of long-term steroid treatment for idiopathic thrombocytopenic purpura . Her symptoms included abdominal pain and weight loss; the only finding of a physical examination was hepatomegaly. We performed computed tomography (CT) and magnetic resonance imaging (MRI) of the liver and a liver biopsy. Based on these findings plus clinical observations, she was diagnosed with peliosis hepatis and her steroid treatment was terminated. The patient recovered completely 3 months after steroid discontinuation, and remained stable over the following 6 months.
Subject(s)
Female , Humans , Middle Aged , Adrenal Cortex Hormones/therapeutic use , Hepatomegaly/complications , Liver/pathology , Magnetic Resonance Imaging , Peliosis Hepatis/complications , Purpura, Thrombocytopenic, Idiopathic/complications , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
No abstract available.
Subject(s)
Adult , Female , Humans , Diagnosis, Differential , Liver/pathology , Peliosis Hepatis/pathology , Tomography, X-Ray ComputedABSTRACT
Peliosis hepatis, an uncommon vascular condition, is characterized by multiple blood-filled cavities distributed throughout the liver. Computed tomography and magnetic resonance imaging findings of peliosis hepatis are nonspecific. A 40-year-old woman presented with multiple hepatic cystic masses. Two years later, the number and sizes of the masses had increased. We suspected metastatic hepatic disease and performed a liver biopsy. Histological examination revealed dilatation of hepatic sinusoids and multiple blood-filled cavities throughout the liver parenchyma. Thus, a diagnosis of peliosis hepatis was confirmed.
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Female , Humans , Biopsy , Dilatation , Liver , Magnetic Resonance Imaging , Peliosis HepatisABSTRACT
Peliosis hepatis is a rare vascular condition of the liver characterized by the presence of cystic blood-fi lled cavities distributed randomly throughout the liver parenchyma. We report a 46 year old female, with dyspepsia. An abdominal Doppler ultrasound showed a hyper vascularized solid liver nodule of 5 cm diameter. Magnetic resonance imaging and CT scan showed the same hyper vascularized nodule. With the possible diagnoses of primary hepatocellular carcinoma or focal nodular hyperplasia, the patient was subjected to an excision of hepatic segment VI, where the nodule was located. The pathological diagnosis of the surgical piece was a peliosis hepatis.
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Female , Humans , Middle Aged , Peliosis Hepatis/diagnosis , Diagnosis, Differential , Focal Nodular Hyperplasia/diagnosis , Liver Neoplasms/diagnosis , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Ultrasonography, Doppler, ColorABSTRACT
Introduction: Peliosis hepatis (PH) is an uncommon condition in pediatrics; however, it is one of the most serious complications associated with the long-term use of use of steroids. It is characterized by multiple blood-filled cavities, mostly involving the liver. Myelodysplastic Syndrome (MDS) is also a complex and infrequent hematological condition; it may transform into acute leukemia and its treatment requires medications that may lead to PH. Case Report: 13 year-old girl with MDS, refractory cytopenia type. A family donor for SCL was not available, therefore immunosuppressive treatment, steroids and transfusions were initiated. Due to metrorrhage, estrogen was used at high doses. She developed acute abdominal pain; abdominal ultrasound and CL scan showed PH and peritoneal bleeding. Oral contraceptives were decreased resulting in reduction of PH, but a new episode of uterine bleeding causing hypovolemic shock forced a hysterectomy in order to suspend estrogen treatment. Due to lack of response to treatment to SMD, she continued been treated with transfusions as needed, and died 32 months post diagnosis. Discussion: PH is an uncommon and life-threatening condition in children receiving prolonged treatment with steroids. Current modalities of SCL in patients with MDS will replace the need for steroids, thus avoiding this severe complication.
Introducción: La Peliosis Hepática (PH) es una condición muy infrecuente en pediatría, caracterizada por la presencia de múltiples cavidades sanguíneas en el parénquima hepático, asociada al uso prolongado de estrógenos o corticoides, El Síndrome Mielodisplásico (SMD) es una alteración hematológica compleja que puede evolucionar a leucemia y que puede requerir para su tratamiento medicamentos relacionados al desarrollo de PH. Caso Clínico: Niña 13 años, con SMD tipo citopenia refractaria, con dependencia transfusional, sin posibilidad de realizar Trasplante de progenitores hematopoyéticos (TPH) por falta de donante familiar compatible. Recibió transfusiones, inmunosupresores y corticoides por tiempo prolongado. Presentó metrorragias severas requiriendo estrógenos en altas dosis. Evolucionó con hemoperitoneo, diagnosticándose PH por ecografía y scanner abdominal. Al reducir dosis de estrógenos disminuyeron lesiones hepáticas, pero nuevo episodio de metrorragia con shock hipovolémico, obligó a realizar histerectomía para suspender estrógenos. Sin respuesta a tratamiento del SMD, se mantuvo con transfusiones según requerimiento y falleció a los 32 meses del diagnóstico. Discusión: La PH es una complicación grave, que podría evitarse con el desarrollo de nuevas técnicas de TPH que permiten contar con donantes no relacionados para el tratamiento de síndromes de falla medular como el SMD.
Subject(s)
Humans , Adolescent , Female , Steroids/adverse effects , Peliosis Hepatis/chemically induced , Myelodysplastic Syndromes/drug therapy , Contraceptives, Oral/adverse effects , Adrenal Cortex Hormones/adverse effects , Steroids/therapeutic use , Fatal Outcome , Peliosis Hepatis/etiology , Myelodysplastic Syndromes/complications , Time FactorsABSTRACT
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.
Subject(s)
Humans , Female , Adult , Tomography, X-Ray Computed/methods , Rupture , Peliosis Hepatis/complications , Necrosis , Hemorrhage/etiologyABSTRACT
No abstract available.
Subject(s)
Adult , Female , Humans , Carcinoma, Hepatocellular/diagnosis , Diagnosis, Differential , Liver Neoplasms/diagnosis , Magnetic Resonance Imaging , Peliosis Hepatis/diagnosis , Tomography, X-Ray ComputedABSTRACT
Peliosis hepatis is an uncommon liver condition involving abnormal dilation of hepatic sinusoids, eventually leading to blood-filled cavities within the hepatic parenchyma. Although the pathogenesis is not understood fully, peliosis hepatis has usually been associated with the use of anabolic steroid therapy, oral contraceptives, various malignancies or tuberculosis. We report a case of 59-year-old patient with cholangiocarcinoma with peliosis hepatis. The patient was admitted for evaluation of abdominal pain and fever. Abdomen CT showed a round cytic and solid mass with peripheral duct dilatation in liver. Grossly, the spongy-like solid mass and cyst was noted. Microscopically, the solid mass was composed of tubular and solid adenocarcinoma in fibrotic stroma and a blood-filled cavity with dilated sinusoids was noted.
Subject(s)
Humans , Middle Aged , Abdomen , Abdominal Pain , Adenocarcinoma , Cholangiocarcinoma , Contraceptives, Oral , Dilatation , Fever , Liver , Peliosis Hepatis , TuberculosisABSTRACT
Peliosis hepatis is characterized by the presence in the liver of blood-filled cavities, which may or may not be lined with sinusoidal cells. The individual cysts or cavities usually do not exceed several centimeters in diameter. The cysts are typically continuous with adjacent, more normal sinusoids, and they sometimes can be seen in continuity with hepatic venous tributaries. The lesion is usually diagnosed by gross or microscopic examination. When suspected, it can be diagnosed by percutaneous liver biopsy. In the past, peliosis hepatis is primarily associated with wasting diseases, such as tuberculosis, malignancy, and chronic suppurative infection. However, recently peliosis hepatis is seen most commonly in association with the administration of anabolic steroids or HIV infection. We report a case of peliosis hepatis that is diagnosed by peritoneoscopic live biopsy and not associated with known disease.