Endoscopic retrograde cholangiopancreatography is a very common therapeutic procedure for a variety of biliary and pancreatic duct diseases. Subcapsular liver hematoma slh is a rare complication of severe preeclampsia and hellp syndrome. A presumptive antenatal diagnosis of a subcapsular liver hematoma sch was made based on the location and ultrasound appearance similar to sch seen in pediatric and adult patients. Hepatic capsular and subcapsular pathologic conditions. A high index of suspicion is essential for early identification and stabilisation of babies with such a pathology. Subcapsular hepatic hematoma in an otherwise uncomplicated pregnancy. Sequential evaluation of the mass showed an evolving ultrasound appearance which reinforced our initial impression of a subcapsular hematoma of the fetal liver. Spontaneous subcapsular hematoma of the fetal liver. Postpartum spontaneous subcapsular hepatic hematoma sshh. There are a lot of therapeutic options varying from conservative management to surgical treatment including hepatic. There isnt active bleeding, and the blood is collected in a sealed area. Chronic subcapsular hepatic hematoma radiology case. Distinction between perirenal and subcapsular collections.
Hematoma subcapsular hepatico roto en sindrome hellp. It is a catastrophic condition that can be caused by maternal, placentar or fetal factors. Findings consistent with residual chronic subcapsular hematoma. Subcapsular hepatic hematoma is an infrequent and severe complication of hypertension in pregnancy and should be suspected when there are clinical signs compatible with this diagnosis, which should be confirmed by abdominal computed tomography. Laparoscopic evacuation of a subcapsular renal hematoma causing symptomatic hypertension. Hematoma subcapsular por fasciolasis liver subcapsular.
Spontaneous subcapsular liver hematoma associated with pregnancy. We report a 54yearold lady presenting high fever, dysuria followed 5 days later by acute onset left flank pain and uncontrolled hypertension. Pdf an obscure case of hepatic subcapsular hematoma. The patient was operated and the presence of a subcapsular hematoma was confirmed. With subcapsular hematoma, the patients symptoms will vary depending on the degree and duration of the bleed. The hematoma is usually located around the right lobe of the liver in 75% of patients. Relief of symptoms occurs rapidly, and clearance of the eosinophilia is obtained in. Very few of these hematomas, however, are clinically significant. An abdominal cat sean showed a subcapsular fluid collection in the liver. The magnitude of the hematoma, presence of hemodynamic instability, and uncertainties about the diagnosis were indications for surgery in these cases.
The woman underwent an emergency caesarean section with the. The subcapsular hematoma is a serious complication, with high risk of maternal and neonatal mortality, it is seen as a complication of hypertensive diseases more frequently, busides another. Case report a 36yearold c aucasian primigravida at 34 weeks of gestation was admitted at our emergency depart ment complaining of nausea, vomiting, mala ise and epigastric, right upper quadrant tand shoulder pain. A 41yearold male, paraplegic for 16 years, presented to the emergency department 3 days after sudden onset of right upper quadrant and shoulder pain. Humberto rosas l 1, carlos fiestas f 2, richard torres m 2, giorgio aita c 2, david lozada m 2. Subcapsular haematoma of the liver rarely occurs in neonates and the diagnosis is often missed or delayed. These outcomes are often fulminant evolution, and maternal mortality amounted to more than 50%. Ultrasound, computed tomography and magnetic resonance imaging showed a subcapsular hematoma in the left kidney.
The most common reported complications are pancreatitis, bleeding, perforation, and infection. The complications can be devastating in terms of fetal and maternal mortality. Descriptive, retrospective study, series of cases type. Urinary infection and spontaneous subcapsular renal hematoma. Here we report a case of a 32yearold primiparous female at 36 weeks of gestation, admitted to a maternity ward of a private clinic for preeclampsia. Initial laboratory showed leukocytosis with 56% of eosinophils. Procedure related complications are more frequent than in other endoscopic procedures. Subcapsular hepatic hematoma secondary to endoscopic retrograde cholangiopancreatography is a rare complication, but is potentially lifethreating. Ruptured subcapsular liver hematoma during pregnancy. A subcapsular hematoma appears as a lowattenuation, elliptic collection of blood between the liver capsule and the liver parenchyma at ct caused by the compression of the underlying liver margin by the thick, fibrous glisson capsule, fig 1. These patients must be followed up in intensive care unit for advanced medical support with infused fluid, replacement of blood products, and treatment of underlying disorders. Subcapsular hepatic hematoma secondary to endoscopic retrograde. Subcapsular hepatic hematoma is an extremely rare complication of ercp, but the occurrence of abdominal pain after ercp should raise the suspicion of this complication.
To determine the clinical characteristics and management of subcapsular hepatic hematoma shh as a result of severe preeclampsia and hellp syndrome in the period 20042016. Percutaneous renal biopsy results in subcapsular hematoma in approximately 28% and in some degree of perirenal hemorrhage in over 90% of patients. Hematoma hepatico subcapsular roto en sindrome hellp. Based on limited reports the clinical presentations of patients with a singular kidney and renal allografts include flank paintenderness, acute renal failure and decreased urine output. Subcapsular liver hematoma hepatic subcapsular hematoma. Conversely, a hepatic hematoma is an injury in which there was bleeding, but it has essentially clotted. Surgical drainage of the subcapsular hematoma may be needed 4, 6, 7. Round, slightly crescentic mass peripherally in the right hepatic lobe containing subtle calcification arrows on noncontrast and showing no contrast enhancement on arterial, pv and delayed imaging all 55 hu. We report a rare case of a ruptured hepatic subcapsular hematoma in the course of in a patient with hellp syndrome as a complication of preeclampsia resulting. Summary hellp syndrome is a rare condition related to pregnancy.
Subcapsular perirenal hematoma radiology reference. The case is presented of a 25 year old patient with choledocholithiasis and cholelithiasis, who developed a subcapsular hepatic hematoma. Readable by all users, writable by nucmed certifiers keywords. Spontaneous subcapsular hematoma of the liver, with no history of preeclampsia and hellp syndrome hemolysis, elevated liver enzymes, and low platelet count.
Postpartum spontaneous subcapsular hepatic hematoma. An obscure case of hepatic subcapsular hematoma article pdf available in case reports in gastroenterology 51. This is a coronal reconstruction of a contrastenhanced ct scan of the abdomen and pelvis. A subcapsular perirenal hematoma is a form of perirenal hematoma where blood accumulates beneath the renal capsular margin. Learning radiology subcapsular, hematoma, renal, laceration. Subcapsular hematoma and laceration of left kidney. Hellp syndrome complicated by subcapsular hematoma of. Spontaneous subcapsular renal hematoma is an uncommon entity. We report a case of subcapsular hematoma of the liver without any apparent lesion and in the absence of coagulopathy. The subcapsular hematoma is a serious complication, with high risk of maternal and neonatal mortality, it is seen as a complication of hypertensive diseases more frequently, busides another serious diseases such as acute fatty liver of pregnancy, trauma, infectious diseases. In addition, there is a lucency traversing the lower pole of the kidney that represents a renal laceration. Subcapsular definition of subcapsular by the free dictionary. In most cases, this is managed surgically, but the mortality rate is high, up to 50% of all patients.
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