Hepatic infarction

Hepartic infarction is an extremely rare situation because of the liver's dual blood supply by the hepatic artery and portal vein. Hepatic infarction can occur when there is both hepatic arterial and portal vein flow compromise but most cases are due to acute portal venous flow compromise 11.

Most cases are seen after liver transplantation or hepatobiliary surgery. Non-transplant cases are mostly caused by 1-2:

Clinically these patient present with abdominal pain, nausea, vomiting and abnormal liver function tests 2. Most of the time, infarction is a peripherally located wedge-shaped area, however it can be centrally or round or oval shape 2.

Ultrasound
  • acute stage
    • an ill defined hypoechoic area with indistinct border
    • gas within sterile infarcted zone can be seen 2-3
  • chronic stage
    • infarcted area becomes anechoic and cystic with distinct borders.

Differentiation between gas within sterile infarcted area and abcess formation by imaging is impossible and fine needle aspiration is needed 2.

CT

Typically infarction presents as an ill-defined wedge-shaped based area of hypo attenuation which is mostly peripheral without pressure effect on adjacent structures in post-contrast images 4-5

MRI

On MRI imaging, regions of hepatic infarction appears as hypo-intense lesion on T1 imaging, with hyper-intensity on T2 imaging 6.

      General imaging differential considerations include:

      • focal fatty infiltration: although focal fatty infiltration lacks pressure effect, vessels are seen crossing trough the lesion
      • hepatic abscess: typically shows pressure effect on adjacent structures and ring enhancement while hepatic infarction lacks pressure effect and any enhancement
      • true hepatic masses: both pressure effect and enhancement differentiates from hepatic infarction. the clinical scenario is different
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      Article information

      rID: 24980
      Tag: cases
      Synonyms or Alternate Spellings:
      • Liver infarction
      • Liver infarctions
      • Hepatic infarctions
      • Infarction of liver
      • Infarction of the liver

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