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. 2021 Mar-Apr;11(2):260-263.
doi: 10.1016/j.jceh.2020.07.004. Epub 2020 Jul 25.

Hemorrhage and Rupture of an Unusual Benign Liver Lesion in Pregnancy: A Case Report

Ayushi Agarwal  1 , Danny Joy  2 , Prasenjit Das  3 , Nihar R Dash  2 , Deep N Srivastava  1 , Kumble S Madhusudhan  1
Affiliations

Hemorrhage and Rupture of an Unusual Benign Liver Lesion in Pregnancy: A Case Report

Ayushi Agarwal et al. J Clin Exp Hepatol. 2021 Mar-Apr.

Abstract

Liver rupture in pregnancy is an acute condition with significant risk to the mother and fetus. It is known to occur with tumors such as hepatic adenoma, infective causes such as abscess, granulomatous diseases, and parasitic infections, and rarely spontaneously. Most of these conditions have overlapping clinicoradiological findings, almost always requiring histopathological confirmation. We report a case of a ruptured hepatic lesion, with an unusual diagnosis of Bartonella henselae infection causing cat-scratch disease, in a 24-year-old pregnant lady.

Keywords: ALFP, Acute liver failure in pregnancy; CSD, Cat-scratch disease; CT, Computed tomography; FNH, Focal nodular hyperplasia; HCC, Hepatocellular carcinoma; HELLP, Hemolysis, elevated liver enzymes, and low platelet; IFA, Immunofluorescent assay; Ig-G, Immunoglobulin-G; MRI, Magnetic resonance imaging; PCR, Polymerase chain reaction; USG, Ultrasonography; cat-scratch disease; hemorrhagic liver lesion; liver rupture in pregnancy.

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Figures

Figure 1
Figure 1
A – Ultrasonography image shows a heteroechoic lesion in segment VI of the liver (arrow) with perihepatic collection (asterisk). B, C – Axial contrast-enhanced CT images show perihepatic hematoma (asterisk) with linear laceration (arrow head) and a heterogeneous lesion in segment VI (arrow). CT, computed tomography.
Figure 2
Figure 2
A – Axial T2-weighted MRI shows a heterogeneous lesion (arrow) in segment VI of the liver with subcapsular hematoma (asterisk). B – Axial T1-weighted MRI shows the lesion appearing iso to hyperintense (arrow) with hematoma (asterisk). C – Contrast enhanced T1-weighted MRI shows nonenhancing cystic areas (arrow) within the lesion, with subcapsular hematoma (asterisk). MRI, magnetic resonance imaging.
Figure 4
Figure 3
A – Right hepatectomy specimen shows capsular breach (arrows) with exophytic lesion in segment VI (asterisk). B – Cut-section through the lesion shows internal haemorrhage (arrows).
Figure 4
Figure 4
A, B - Histology (H and E stain) of liver lesion shows a geographical abscess (arrows in A; H and E stain, x40) surrounded by palisaded histiocytes (arrows in B; x100). C - Warthin–Starry stain shows a few curved stain-positive bacilli within the abscess cavities suggestive of Bartonella henselae (x 400).
See this image and copyright information in PMC

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