Hepatic veno-occlusive disease

Hepatic veno-occlusive disease (VOD), also known as sinusoidal obstruction syndrome (SOS), is a condition arising from occlusion of hepatic venules.

Toxic injury to liver sinusoids causes sloughing of endothelial cells which embolise to hepatic venules and cause eventual fibrosis of the venules. This results in hepatic congestion (similar to Budd-Chiari syndrome) and post-sinusoidal portal hypertension.

Aetiology
  • bone marrow transplantation
  • chemotherapy, includes systemic neo-adjuvant chemotherapy in metastatic colorectal cancer, particularly the use of oxaliplatin
  • pyrrolizidine alkaloids (Jamaican bush tea)
Ultrasound

Imaging modality of choice which may show:

  • hepatomegaly 
  • portal vein abnormalities:
    • portal vein dilatation
    • portal venous pulsatility
    • hepatofugal portal venous flow
  • elevated hepatic artery resistive index (> 0.8)
  • loss of triphasic hepatic venous flow
  • gallbladder wall thickening (> 6-8 mm)
  • ascites
CT
MRI

Recent MRI studies with hepatocyte specific contrast agent show diffuse hypointense reticular pattern on post-contrast T1 delayed hepatobiliary phase as a highly specific sign for diagnosis.

There is no standard treatment regimen but options include:

  • anticoagulation
  • vasodilators
  • supportive care

Preoperative planning for hepatic metastectomy should include exclusion of SOS after use of chemotherapy as there is increased risk of  postoperative liver failure.

Approximately half resolve but high mortality in severe cases (up to 90%).

Complications
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Article Information

rID: 1441
Section: Pathology
Tags: cases, snippet
Synonyms or Alternate Spellings:
  • Hepatic venoocclusive disease
  • Sinusoidal obstruction syndrome (SOS)
  • Sinusoidal obstruction syndrome
  • VOD

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