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Multiple hepatic infarctions secondary to diabetic ketoacidosis:A case report

World Journal of Hepatology 2022年第11期14卷 1977-1984页

作者： Vitoria Mikaelly da Silva Gomes Gustavo de Sousa Arantes Ferreira Luise Cristina Torres Rubim de Barros Barbara Moreira Ribeiro Trindade dos Santos Lorenna Paulinelli Bahia Vieira Department of General Surgery Hospital das Clinicas da Universidade Federal de Minas GeraisBelo Horizonte 30130100Minas GeraisBrazil Instituto de Cardiologia do Distrito Federal Brasilia 70673900Distrito FederalBrazil Department of General Surgery Hospital Metropolitano Doutor Celio de CastroBelo Horizonte 30620090Minas GeraisBrazil

BACKGROUND Hepatic infarctions(HI)are ischemic events of the liver in which a disruption in the blood flow to the hepatocytes leads to focal ischemia and necrosis.Most HI are due to occlusive events in the liver’s blood vessels,but non-occlusive HI may occur.They are associated with disruption of microvasculature,such as in diabetic ketoacidosis.While HI usually presents as peripheral lesions with clear borders,irregular nodular lesions may occur,indistinguishable from liver neoplasms and presenting a diagnostic challenge.CASE SUMMARY We report a case of multiple extensive HI in a patient with poorly controlled diabetes mellitus,who first presented to the emergency room with diabetic ketoacidosis.He then developed jaundice,thrombocytopenia,and a marked elevation of serum aminotransferases.An ultrasound of the liver showed the presence of multiple irregular lesions.Further investigation with a computerized tomography scan confirmed the presence of multiple hypoattenuating nodules with irregular borders and heterogeneous appearance.These lesions were considered highly suggestive of a primary neoplasm of the liver.While the patient was clinically stable,his bilirubin levels remained persistently elevated,and he underwent an ultrasound-guided percutaneous biopsy of the largest lesion.Biopsy results revealed extensive ischemic necrosis of hepatocytes,with no signs of associated malignancy.Three months after the symptoms,the patient showed great improvement in all clinical and laboratory parameters and extensive regression of the lesions on imaging exams.CONCLUSION This case highlights that diabetic ketoacidosis can cause non-occlusive HI,possibly presenting as nodular lesions indistinguishable from neoplasms.

关键词： Hepatic infarction Non-occlusive infarcts Diabetic ketoacidosis pseudotumor of the liver liver infarcts Case report

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