Rapidly Progressing Hepatic Failure caused by Congestive Hepatic Necrosis of Lateral Segment of the Liver due to Secondary Budd-Chiari Syndrome

Masanori Matsuda, Hideki Fujii, Masatoshi Mogaki and Yoshiro Matsumoto

First Department of Surgery, Yamanashi Medical University

A 44-year-old man was admitted to our hospital because of hepatic tumor detected by ultrasonography during follow-up for chronic hepatitis B. In January 1995, he underwent right lobectomy of the liver for a tumor 6.0 cm in diameter and with a diagnosis of hepatocellular carcinoma (HCC). The resected specimen showed moderately differentiated HCC with capsular infiltration and satellite nodules around the main tumor. He received hepatic arterial infusion chemotherapy. In March 1996, 2 recurrent HCC nodules were detected in the medial and lateral segments of the liver. Microwave coagulation therapy under laparotomy was performed. Computed tomography (CT) in August 1996 revealed multiple recurrent tumors in the left lobe of the liver and a tumor embolus in the middle hepatic vein which extended to the inferior vena cava. After October 10, he developed grade I to II hepatic coma. CT showed the tumor embolus in the middle hepatic vein now extended to the right atrium. Low density in the lateral segment suggested congestion. His hepatic failure progressed very rapidly after that and he died on October 29. Autopsy revealed congestive hepatic necrosis in the lateral segment of the liver caused by an out flow obstruction of the left hepatic vein orifice by the tumor embolus extending from middle hepatic vein. We speculated that the rapidly progressing hepatic failure was due to this secondary Budd-Chiari syndrome.

Key words
Budd-Chiari syndrome due to hepatocellular carcinoma, venous out flow obstruction, liver failure

Reprint requests
Masanori Matsuda First Department of Surgery, Yamanashi Medical University Tamaho-machi, Nakakoma-gunn, Yamanashi, 409-3898 JAPAN

Accepted
December 9, 1998

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