CT and MRI findings of cirrhosis-related benign nodules with ischaemia or infarction after variceal bleeding

Hepatic Failure

The progression of liver disease can cause several physiologic derangements that may precipitate hepatic failure and require admission to an intensive care unit. The underlying pathology may be acute, acute-on chronic, or chronic in nature. Liver failure may manifest with a variety of clinical signs and symptoms that need prompt attention. The compromised synthetic and metabolic activity of the failing liver affects all organ systems, from neurologic to integumentary. Supportive care and specific therapies should be instituted in order to improve outcome and minimize time of recovery.

In this chapter we will discuss the definition, clinical manifestations, workup, and management of acute and chronic liver failure and the general principles of treatment of these patients. Management of liver failure secondary to certain common etiologies will also be presented. Finally, liver transplantation and alternative therapies will also be discussed.

Frequency, CT findings, and fate of multiple infarcted regenerative nodules in liver cirrhosis after variceal bleeding or septic shock

PURPOSE

To evaluate the frequency, CT findings, and fate of multiple infarcted regenerative nodules in patients with liver cirrhosis after variceal bleeding or septic shock.

METHODS

During a recent 3-year period, 492 patients with hematemesis or melena (n = 445) and septic shock (n = 47) in liver cirrhosis visited our hospital. After applying the exclusion criteria, 136 patients with active variceal bleeding and 29 patients with septic shock were finally included in the study. We diagnosed multiple infarcted regenerative nodules based on the findings of the first follow-up (within 30 days) CT after events. We evaluated the shape, number, size, margin, location, and distribution of the infarcted regenerative nodules.

RESULTS

Thirty-four patients were diagnosed with multiple infarcted regenerative nodules (20.6% [34/165]): 29 among 136 patients with variceal bleeding (21.3% [29/136]) and 5 among 29 patients with septic shock (17.2% [5/29]). Most of the infarcted regenerative nodules were round in shape, more than ten in number (79.4%), measured 1 cm or less (76.3%), had well-defined margins (61.8%), were present in the periphery (67.6%), and had a clustered distribution (67.6%). Almost all of the infarcted regenerative nodules disappeared on the second follow-up CT (88.9% [16/18]).

CONCLUSIONS

In cirrhotic patients, multiple infarcted regenerative nodules were not rare (they were found in about one-fifth of the patients) on the first follow-up CT after variceal bleeding or septic shock. Majority of the infarcted regenerative nodules were more than ten in number, measured 1 cm or less, were located in the periphery, and had a clustered distribution.