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• W3157133670 abstract "A 30-year-old woman without antenatal care presented with 10 hours of right upper quadrant pain, which developed immediately after vaginal delivery. On examination, she was conscious and afebrile, with a pulse rate of 146 beats/min and blood pressure of 230/179 mm Hg. Palpation demonstrated right upper quadrant tenderness. Laboratory test results were noteworthy for a serum bilirubin level of 4.3 mg/dL (reference range 0.3 to 1.0 mg/dL), alanine aminotransferase level of 558 IU/L (reference range 7 to 52 IU/L), and platelet count of 40×103/μL. Point-of-care ultrasonography of the abdomen was performed (Figure 1 and Video E1, available online at http://www.annemergmed.com/), and the diagnosis was confirmed by contrast-enhanced computed tomography (CT) (Figure 2).Figure 2Abdominal CT scan demonstrating multiple inhomogeneous, hypoattenuating, wedge-shaped, peripheral liver lesions (arrowhead), compatible with infarction.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Liver infarction, acute stage. Liver infarction is an uncommon but ominous development in pregnant women and may be associated with hemolysis, elevated liver enzyme levels, and low platelet syndrome.1Khong S.-Y. James M. Smith P. Diagnosis of liver infarction postpartum.Obstet Gynecol. 2005; 105: 1271-1273Crossref PubMed Scopus (8) Google Scholar Typical CT images of liver infarction show hypoattenuating, wedge shaped, and mostly peripheral lesions, which can be distinguished from other diseases by ultrasonography or magnetic resonance imaging.2Zissin R. Yaffe D. Fejgin M. et al.Hepatic infarction in preeclampsia as part of the HELLP syndrome: CT appearance.Abdom Imaging. 1999; 24: 594-596Crossref PubMed Scopus (31) Google Scholar Recently, the “bright band sign” of ultrasonography has been emphasized in differentiating liver infarct from abscess.3Whang G. Chopra S. Tchelepi H. “Bright band sign”: a grayscale ultrasound finding in hepatic infarction.J Ultrasound Med. 2019; 38: 2515-2520Crossref PubMed Scopus (1) Google Scholar The patient was admitted to the ICU for supportive care. Serial liver enzyme level tests and liver ultrasonography demonstrated improvement during the following week, and she was discharged uneventfully 25 days later. https://www.annemergmed.com/cms/asset/686140eb-ccfc-40e1-97b4-ca07590a4ebf/mmc1.mp4Loading ... Download .mp4 (2.42 MB) Help with .mp4 files Video E1Ultrasonography showing an inhomogeneous, hypoattenuating, wedge-shaped, peripheral liver lesion (arrowhead) with bright band sign (arrow) (visible at 00:02) and decreased color flow (visible at 00:05 to 00:09)." @default.
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• W3157133670 date "2021-05-01" @default.
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• W3157133670 title "A Postpartum Woman With Right Upper Quadrant Pain and Jaundice" @default.
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• W3157133670 doi "https://doi.org/10.1016/j.annemergmed.2020.10.015" @default.
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