332.文献摘读：Radiologic Mimics of Cirrhosis（4）

每天朗读一段医学影像学英语文章

Fulminant Hepatic Failure

Fulminant hepatic failure constitutes acute severe impairment of hepatic function in the absence of preexisting liver disease and receives higher priority for hepatic transplantation than hepatic failure developing in the setting of cirrhosis. The distinction of acute from acute-on-chronic hepatic failure may be clinically difficult and hepatic surface nodularity might be considered indicative of underlying cirrhosis, adversely impacting transplantation status. Recently, fulminant hepatic failure alone was shown to result in diffuse surface nodularity because of a combination of alternating foci of confluent regenerative nodules and necrosis rather than cirrhosis (Figs. 4A, 4B and 5).

Fig. 4A —61-year-old man with fulminant hepatic failure and history of chronic hepatitis B infection. Contrast-enhanced CT image shows nodularity (arrow) of liver surface outlined by ascites; these findings are suggestive of cirrhosis. Histopathologic examination of explanted liver 5 days later showed confluent regenerative nodules surrounded by large areas of necrosis, but no cirrhosis. Hepatic surface nodularity is not a reliable sign of underlying cirrhosis in fulminant hepatic failure and should not be used to diagnose cirrhosis in this setting.

Fig. 4B —61-year-old man with fulminant hepatic failure and history of chronic hepatitis B infection. Photomicrograph of explanted hepatic surface from transplant surgery performed 5 days after A shows that irregularity of liver surface reflects combination of confluent regenerative nodules (R) and alternating bands of necrosis (N). (H and E, ×200)

Fig. 5 —67-year-old woman with fulminant hepatic failure that developed 6 weeks after commencement of methyldopa therapy for hypertension. Sagittal ultrasound image of right hepatic lobe shows nodularity (arrow) of liver surface outlined by ascites; these findings are suggestive of cirrhosis. Histopathologic examination of explanted liver 3 days later showed confluent regenerative nodules surrounded by large areas of subacute necrosis but no cirrhosis.

Notes:

1. fulminant /ˈfʊlmənənt/ adj. (疾病)暴发性的

2. necrosis /nɛ'krosɪs/ n. 坏疽；坏死

3. cirrhosis /sə'rosɪs/ n. 肝硬化

来源：每天朗读一段医学影像学英语文章

圈主

深圳市人民医院放射科副主任医师杨敏洁

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