Acute liver failure - chemotherapy induced

Case contributed by Levon Davtyan


RUQ pain. History of breast cancer, underwent segmental resection of the breast, radiotherapy, and chemotherapy.

Patient Data

Age: 40 years
Gender: Female

Initial CT


There is no liver metastasis and/or parenchymal heterogeneity. Few minute cysts are only noted. No ascites.

1 month later during chemotherapy, the patient presented with RUQ pain with elevated liver enzymes and inflammatory markers. 

1 month later

  • The liver is markedly enlarged and has a craniocaudal dimension of 24 cm
  • Hepatic parenchymal heterogeneity is visible on contrast-enhanced CT scans
  • The gallbladder wall is mildly thickened with pericholecystic fluid
  • Mild pelvic and perihepatic ascites
  • Hepatic simple cysts are visible in segment VI
  • Right breast segmental resection and mediastinal lymphadenopathy
  • Mild right-sided pleural effusion
  • Hypodense metastatic lesions in the left femoral head (white arrow) and vertebrae (not shown)

Case Discussion

Here is a case of acute liver failure after chemotherapy with metastases from breast cancer affecting the lungs, bones, and mediastinal lymph nodes. Acute liver failure has a high mortality  (~50%). Unfortunately, the patient passed after two days.

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