Case 108: Hepatocellular Necrosis

Diagnostic Category:

Clinical Presentation:

53 year old man with Hepatitis B and C related cirrhosis. Metabolically decompensated shortly after initiation of ribavirin and interferon therapy while being on the liver transplant list. Elevation of AST (GOT) over 3000 U/l, total bilirubin 31 mg/dl, INR 2.

CT: In cirrhotic liver - with periportal and lobar predominance

Imaging Findings:

Unenhanced CT: intrahepatic vessels are indistinguishable from hepatic parenchyma, consistent with steatosis hepatis or hepatic edema.

After IV contrast administration subtotal non-wedge shaped parenchymal perfusion defects predominantly of the right hepatic lobe. Also perfusion defects with periportal predominance in the left lobe. Note patent portal vein, distinguishing hepatocellular necrosis from vascular infarction, and largely malperfused right lobe due to edema and necrosis. Patient expired 10 days after this CT due to massive variceal hemorrhage.