Case 109: Hepatocellular Necrosis

Diagnostic Category:

Clinical Presentation:

63 year old man with several weeks of abdominal pain for which he had been self medicating with pepto bismol and acetaminophen. The patient reported that he only took the instructed amount of both medications. Now fulminant liver failure with AST (GOT) 6247U/lm ALT (GPT) 1877U/l, total bilirubin 0.4 mg/d; INR 1.1.

CT: In non-cirrhotic liver

Imaging Findings:

CT shows random distribution of non perfused parenchyma, only some of which demonstrating a wedge shaped configuration suggestive of infarctions. Non-wedge shaped necrotic liver portions are typical for hepatocellular necrosis, given the patent portal and hepatic veins. No hepatic tumors identified even though malignant cells of unknown primary origin were found in the ascitic fluid. The patient expired 4 days later with hepatorenal and respiratory failure.