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Clinical characteristics, CT signs, and pathological findings of Pyrrolizidine alkaloids-induced sinusoidal obstructive syndrome: a retrospective study

Authors
  • Liu, Fang1
  • Rong, Xinxin1
  • Guo, Hui2
  • Xu, Dong2
  • Liu, Chang1
  • Meng, Lingling1
  • Yang, Xiaoqian1
  • Guo, Tingting1
  • Kan, Xuefeng1
  • Song, Yuhu1
  • 1 Huazhong University of Science and Technology, Wuhan, 430022, China , Wuhan (China)
  • 2 Huazhong University of Science and Technology, Wuhan, 430030, China , Wuhan (China)
Type
Published Article
Journal
BMC Gastroenterology
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Feb 04, 2020
Volume
20
Issue
1
Identifiers
DOI: 10.1186/s12876-020-1180-0
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundOne major etiology of hepatic sinusoidal obstruction syndrome (HSOS) in China is the intake of pyrrolizidine alkaloids (PAs). Since PAs-induced HSOS is a rare disease that has not been clearly characterized until now, the aim of this study was to investigate clinical characteristics, CT features, and pathological findings of PA-induced HSOS.MethodsThis retrospective cohort study included 116 patients with PAs-induced HSOS and 68 patients with Budd-Chiari syndrome from Jan 2006 to Sep 2016. We collected medical records of the patients, and reviewed image features of CT, and analyzed pathological findings.ResultsCommon clinical manifestations of PAs-induced HSOS were abdominal distention (98.26%), ascites (100%), jaundice (52.94%), abdominal pain (36.36%). Abnormal liver function was observed in most of PAs-induced HSOS. On CT scan, common findings included: ascites, hepatomegaly, the thickening of gallbladder wall, pleural effusion, patchy liver enhancement, and heterogeneous hypoattenuation. Most of the patients had a low ascitic total protein (< 25 g/L) and a high SAAG (≥ 11.0 g/L). In acute stage, pathologic features were massive sinusoidal dilatation, sinusoidal congestion, the extravasation of erythrocytes, hepatocellular necrosis, the accumulation of macrophages, the deposition of hemosiderin. In subacute stage, complete loss of pericentral hepatocytes, sinusoidal dilatation, the deposition of pigment granules were observed.ConclusionsThe PAs-induced HSOS patients displayed distinct clinical characteristics, imaging features, and pathological findings, which provided some evidences for the diagnosis of PAs-induced HSOS.Trial registrationChiCTR-DRD-17010709.

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