One of the most important causes of acute hepatitis is vascular pathologies of the liver. There are several well-recognized forms of vascular injury to the liver, including Budd-Chiari syndrome, ischemic hepatitis, hepatic infarction and passive congestion due to hemodynamic instability. We present a case of acute liver injury accompanied by hemodynamic and respiratory pathologies.
A 53-year-old lady was admitted to the emergency department with complaints of abdominal pain, nausea, vomiting for a week. Gastrointestinal examination was normal. Laboratory tests revealed mild thrombocytopenia, prolonged international normalized ratio (INR) and transaminases were ten-fold higher. In abdominal ultrasonography, no signs of chronic liver failure and vascular pathologies. Abdominal computed tomography (CT) revealed no pathology. Transthoracic echocardiography disclosed severe mitral regurgitation and dilatation of both atria and right ventricle. Pro-BNP level was increased. Thorax CT demonstrated filling defect compatible with pulmonary thromboembolism (PTE). The patient was accepted PTE, and enoxaparin treatment was initiated. Under the anticoagulant and diuretic treatments, the patient's orthopnea disappeared, control blood values declined.
Acute liver injury can be the initial presentation in a patient with severe valvular disease and acute PTE.