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      Atrofia lobar hepática: A propósito de un caso

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          Abstract

          La atrofia lobar hepática es una condición patológica bastante rara, encontrándose pocos reportes de casos en la literatura. Nosotros presentamos el caso de una paciente de 65 años con antecedente de esclerosis múltiple, quien acudió a la consulta por persistencia de alteración del perfil hepático: elevación de transaminasas, fosfatasa alcalina y bilirrubina total, a expensas de la directa, encontrándose asintomática al momento de la evaluación. Se le diagnóstica Cirrosis Biliar Primaria e inicia tratamiento con ácido ursodeoxicólico (URSO), con mejoría del perfil bioquímico hepático. Durante los controles con métodos de imágenes: ecosonograma abdominal y Tomografía Axial Computarizada, se aprecia atrofia progresiva del lóbulo hepático derecho e hipertrofia del lóbulo hepático izquierdo, el cual llega a ocupar el hipocondrio izquierdo.

          Translated abstract

          Lobar atrophy of the liver is a quite rare pathological condition, with only a few reported cases in the literature. We present the case of a 65 yearold patient , with multiple sclerosis who attended our clinic with abnormal liver tests showing high ALT, AST , Bilirrubin and alkaline phosphatase, and high IgG and IgM, AMA positive, Primary Biliary Cirrhosis was diagnosed and she was started on URSO, with improvement of the hepatic biochemical profile. During the follow up abdominal ultrasound and CT scans were performed, we observed progressive atrophy of the right hepatic lobe and a very important hypertrophy of the left hepatic lobe.

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          Hepatic lobar atrophy: association with ipsilateral portal vein obstruction.

          This study was performed to evaluate the association between hepatic lobar atrophy, bile duct obstruction, and portal vein obstruction. Thirty cases of hepatic lobar atrophy identified on angiography with CT during arterial portography from August 1992 to March 1995 were retrospectively reviewed by two independent observers. Cases were evaluated for vascular patency and bile duct obstruction. Malignant diagnoses were present in 28 of 30 patients. Twenty-two patients (73%) had atrophy in the left lobe and eight patients (27%) had right lobar atrophy. Portal vein obstruction was unilateral and confined to the atrophic lobe in 26 patients (87%). In contrast, bile duct obstruction was bilateral in 23 patients (77%) and in only four patients (13%) was it isolated to the atrophic lobe. The correlation between atrophy and portal vein obstruction was significant, with 90% sensitivity, 97% specificity, and 96% positive predictive value (p < .00001). For the correlation between atrophy and biliary obstruction, the sensitivity of angiography with CT during arterial portography was 90%, specificity was 23%, and positive predictive value was 54% (p = .17). Hepatic lobar atrophy usually occurs in the setting of combined biliary and portal vein obstruction. A significant correlation exists between hepatic lobar atrophy and ipsilateral portal vein obstruction.
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            Extreme right lobar atrophy of the liver: a rare complication of autoimmune hepatitis.

            Lobar atrophy is a rare morphologic change of the liver. We describe a 73-year-old woman with mild liver dysfunction and history of Sjögren's syndrome who had right hepatic lobar atrophy. Serum biochemistry levels were as follows: albumin, 4.5 g/dl; total bilirubin, 1.0 mg/dl; alanine aminotransferase, 25 international units/l; aspartate aminotransferase, 27 international units/l; alkaline phosphatase, 333 international units/l; and gamma-glutamyl transpeptidase, 332 international units/l. Serological data were as follows: rheumatoid factor, 27.9; anti-nuclear antibody, 1:640; and antismooth muscle antibody, 1:80. Viral markers for hepatitis B were all negative. Anti-hepatitis C virus (anti-c-100) was negative. Portal hypertension developed thereafter, and the patient died of hepatic failure at age 76. Postmortem examination revealed autoimmune hepatitis with moderate fibrosis, portal vein thrombus, and complete obstruction of the right hepatic duct due to hepatolithiasis. Terminal hepatic failure resulted from combination of decreased hepatic volume due to the right lobar atrophy, exacerbation of autoimmune hepatitis in the remnant left hepatic lobe, decreased portal venous blood flow due to thrombosis, portal hypertension, and cholangitis with hepatolithiasis. This is the first reported case of hepatic lobar atrophy due to autoimmune hepatitis. From a clinical standpoint, patients with hepatic lobar atrophy, even if asymptomatic, should be followed up with careful attention to progression of liver diseases, portal hypertension, and biliary complications.
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              Hepatic lobar atrophy: association with ipsilateral portal vein obstruction

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                gen
                Gen
                Gen
                Sociedad Venezolana de Gastroentereología (Caracas )
                0016-3503
                June 2007
                : 61
                : 2
                : 128-131
                Affiliations
                [1 ] Clínica Félix Boada Venezuela
                [2 ] CMDLT Venezuela
                [3 ] Policlínica Metropolitana Venezuela
                Article
                S0016-35032007000200013
                6def3744-3574-4e95-9bb7-f9288b6e06f9

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0016-3503&lng=en

                Hepatic lobar atrophy,abnormal liver chemistry tests,abdominal ultrasound,CT Scan,atrofia lobar hepática,alteración del perfil bioquímico hepático,ecosonograma abdominal,tomografía axial computarizada

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