Hepatic infarction

Last revised by Henry Knipe ◉ ◈ on 6 Jan 2023

Citation, DOI, disclosures and article data

Citation:

Ali S, Knipe H, Weerakkody Y, et al. Hepatic infarction. Reference article, Radiopaedia.org (Accessed on 01 Oct 2023) https://doi.org/10.53347/rID-24980

DOI:

https://doi.org/10.53347/rID-24980

Permalink:

https://radiopaedia.org/articles/24980

rID:

24980

Article created:

25 Sep 2013, Shoorangiz Ali

Disclosures:

At the time the article was created Shoorangiz Ali had no recorded disclosures.

View Shoorangiz Ali's current disclosures

Last revised:

6 Jan 2023, Henry Knipe ◉ ◈

Disclosures:

At the time the article was last revised Henry Knipe had the following disclosures:

Integral Diagnostics, Shareholder (ongoing)
Micro-X Ltd, Shareholder (ongoing)

These were assessed during peer review and were determined to not be relevant to the changes that were made.

View Henry Knipe's current disclosures

Revisions:

24 times, by 13 contributors - see full revision history and disclosures

Systems:

Hepatobiliary

Synonyms:

Liver infarction
Liver infarctions
Hepatic infarctions
Infarction of liver
Infarction of the liver

Hepatic infarction is an extremely rare situation because the liver has a dual blood supply from 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.

hepatic artery occlusion due to
- arteriosclerosis
- thrombosis or emboli
- hepatic artery aneurysm
- polyarteritis nodosa
- sickle cell disease
infarction without hepatic artery occlusion is mainly caused by
- acute shock state/systemic hypotension
- trauma
- hypercoagulable state
- preeclampsia, eclampsia and postpartum HELLP syndrome ^4-10
- complication of anesthesia

Clinical presentation

Clinically, these patients 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.

Radiographic features

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 abscess formation by imaging is impossible and fine needle aspiration is needed ².

CT

Typically infarction presents as an ill-defined wedge-shaped area of hypoattenuation which is mostly peripheral without mass-effect on adjacent structures in post-contrast images ^4,5.

MRI

On MRI imaging, regions of hepatic infarction appears as hypointense lesion on T1 imaging, with hyperintensity on T2 imaging ⁶.

Differential diagnosis

General imaging differential considerations include:

focal hepatic steatosis: focal fatty infiltration also lacks mass effect, however vessels are seen crossing through the lesion
hepatic abscess: typically shows mass effect on adjacent structures and ring-enhancement while hepatic infarction lacks mass-effect and any enhancement
true hepatic masses: both mass effect and enhancement differentiate from hepatic infarction, and the clinical scenario is different
emphysematous hepatitis: when gas is present, usually no mass effect