Multiple hepatic infarctions secondary to diabetic ketoacidosis:A case report  

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 

机构地区：[1]Department of General Surgery,Hospital das Clinicas da Universidade Federal de Minas Gerais,Belo Horizonte 30130100,Minas Gerais,Brazil [2]Instituto de Cardiologia do Distrito Federal,Brasilia 70673900,Distrito Federal,Brazil [3]Department of General Surgery,Hospital Metropolitano Doutor Celio de Castro,Belo Horizonte 30620090,Minas Gerais,Brazil

出　　处：《World Journal of Hepatology》2022年第11期1977-1984,共8页世界肝病学杂志（英文版）（电子版）

摘　　要：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 

分 类 号：R587.2[医药卫生—内分泌] R575[医药卫生—内科学]