Acute liver failure (ALF), also known as fulminant hepatic failure, refers to sudden severe liver dysfunction from injury without underlying chronic liver disease (CLD), although sometimes it presents as decompensation of an unknown CLD.
ALF is rare, with < 1 case per 100,000 in the developed world 5.
Symptoms and signs of hepatic encephalopathy and/or coagulopathy are the most common presentation.
There are many causes for ALF 1,3,4:
- viral infection, hepatitis B is probably the most common 5,6
- idiopathic (15%), i.e. cause unknown
- drug toxicity, e.g. paracetamol/acetaminophen toxicity, chemotherapeutic agents
- toxin exposure, e.g. toxic mushrooms, carbon tetrachloride (industrial chemical), aflatoxin 7
- metabolic disease, e.g. Wilson disease, Reye disease, acute fatty liver of pregnancy, HELLP syndrome
- vascular causes, e.g. Budd-Chiari syndrome, right heart failure, shock
- autoimmune hepatitis
General features may include:
Features of cirrhosis (i.e. splenomegaly, enlarged collateral vessels, liver surface nodularity) are present in 20-30% of patients with ALF, although it should be stressed that patients with ALF do not have cirrhosis 3.
- early: decreased liver echogenicity (cf. right kidney)
- late: the liver becomes heterogeneously echogenic 1
CT may demonstrate the general imaging features along with heterogeneous enhancement on portal venous phase imaging 3.
Treatment and prognosis
Mortality is high in ALF at ~50% (range 30-70%) with orthotopic liver transplant considered the definitive treatment 3,4.
- 1. Diagnostic and Interventional Radiology in Liver Transplantation (Medical Radiology). Springer. ISBN:3642629504. Read it at Google Books - Find it at Amazon
- 2. Mirvis SE, Soto JA, Shanmuganathan K et-al. Problem Solving in Emergency Radiology: Expert Consult - Online. Saunders. ISBN:B00N04AZQC. Read it at Google Books - Find it at Amazon
- 3. Romero M, Palmer SL, Kahn JA et-al. Imaging appearance in acute liver failure: correlation with clinical and pathology findings. Dig. Dis. Sci. 2014;59 (8): 1987-95. doi:10.1007/s10620-014-3106-6 - Pubmed citation
- 4. Gershwin ME, Vierling JM, Manns MP. Liver Immunology. Springer International Publishing. ISBN:B00GRNSQR8. Read it at Google Books - Find it at Amazon
- 5. Bernal W, Wendon J. Acute liver failure. N. Engl. J. Med. 2013;369 (26): 2525-34. doi:10.1056/NEJMra1208937 - Pubmed citation
- 6. Gotthardt D, Riediger C, Weiss KH et-al. Fulminant hepatic failure: etiology and indications for liver transplantation. Nephrol. Dial. Transplant. 2007;22 Suppl 8 (suppl 8): viii5-viii8. doi:10.1093/ndt/gfm650 - Pubmed citation
- 7. Drug-Induced Liver Disease, Third Edition. Academic Press. ISBN:0123878179. Read it at Google Books - Find it at Amazon