Case list for Hepatocellular Necrosis
There are 2 CT cases with this diagnosis.
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.
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.