Unusual clinical course, Challenging differential diagnosis, Rare disease
Tarek Almouradi, Paul Co, William Riles, Bashar Attar
Division of Gatsroenterology and Hepatology, Department of Medicine, John H. Stroger Hospital of Cook County, Chciago, USA
Am J Case Rep 2014; 15:382-387
Isolated hepatic artery thrombosis is an extremely rare condition with only a few cases reported in the literature.
Case Report: A 62-year-old woman presented with a 5-day history of right upper quadrant abdominal pain associated with nausea and vomiting. Physical examination revealed right upper quadrant tenderness.
Her initial laboratory work was significant for elevated aspartate aminotransferase and alanine aminotransferase levels (745 and 431 U/L, respectively).
A computed tomography of her abdomen showed a thrombus within the hepatic artery, with multiple hepatic infarcts but no evidence of portal vein thrombosis. Hypercoagulability workup was unremarkable; she did not have any evidence of atrial fibrillation on ECG or telemetry. She was treated with subcutaneous low molecular weight heparin.
Over the course of her hospitalization, her AST and ALT levels peaked to 2065 and 1217 U/L respectively, and trended down thereafter.
Conclusions: We believe that our case is unique for 2 reasons: 1) Our patient did not undergo any procedure that may have precipitated hepatic artery thrombosis and 2) Despite the absence of concurrent portal vein thrombosis, she had biochemical and imaging findings of hepatic ischemia.
Keywords: Diagnosis, Differential, Angiography, Electrocardiography, Hepatic Artery, Infarction - etiology, Liver - blood supply, Thrombosis - diagnosis, Tomography, X-Ray Computed