Maxime Ronot1,2,3, Anne Kerbaol4,5, Pierre-Emmanuel Rautou5,6, Giuseppe Brancatelli7, Pierre Bedossa5,8,9, Dominique Cazals-Hatem9, Dominique-Charles Valla5,6, Valérie Vilgrain4,5,8. 1. Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon Hospital, Hauts-de-Seine, 100 bd general Leclerc, 92118, Clichy, France. maxime.ronot@bjn.aphp.fr. 2. University Paris Diderot, Sorbonne Paris Cité, Paris, France. maxime.ronot@bjn.aphp.fr. 3. INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France. maxime.ronot@bjn.aphp.fr. 4. Department of Radiology, University Hospitals Paris Nord Val de Seine, Beaujon Hospital, Hauts-de-Seine, 100 bd general Leclerc, 92118, Clichy, France. 5. University Paris Diderot, Sorbonne Paris Cité, Paris, France. 6. Department of Hepatology and DHU Unity, University Hospitals Paris Nord Val de Seine, Beaujon, Hauts-de-Seine, Clichy, France. 7. Section of Radiology, University of Palermo, Palermo, Italy. 8. INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France. 9. Department of Pathology, University Hospitals Paris Nord Val de Seine, Beaujon, Hauts-de-Seine, Clichy, France.
Abstract
PURPOSE: To report the association of a mosaic enhancement pattern on contrast-enhanced CT or MR imaging and hepatic sinusoidal dilatation (SD) with acute inflammatory conditions affecting extrahepatic organs. METHODS: From 2007 to 2012, patients with acute inflammatory diseases who underwent contrast-enhanced CT and/or MRI of the liver with a mosaic enhancement pattern were selected. Clinico-biological and other imaging features were collected at diagnosis and during follow-up. RESULTS: Sixteen patients were included (15 women, median age 27 years; range 18-68). Five women (33 %) were receiving oral contraceptives. Acute inflammatory diseases included pyelonephritis (n = 10), pancreatitis (n = 2), pneumonia (n = 1), septicemia (n = 1), active Crohn's disease (n = 1), and infectious colitis (n = 1). Median white blood cell count was 13,250 cells/μL (range 11,500-18,000 cells/μL) and CRP level 94 mg/L (range 60-121 mg/L). Mosaic enhancement pattern was present in the whole liver and was prominent in the subcapsular areas. Four patients underwent liver biopsy confirming SD. Eleven patients underwent follow-up imaging showing normalized aspect in 9/11 patients after a median of 2 months. CONCLUSION: Acute diseases of extrahepatic organs, associated with a marked systemic inflammatory syndrome should be added to the list of conditions causing a reversible hepatic sinusoidal dilatation as manifested by a mosaic enhancement pattern on contrast-enhanced CT or MR imaging. KEY POINTS: • Acute extrahepatic infectious/inflammatory diseases are a cause of transient MP. • In most patients, MP was seen during both arterial and portal venous phase. • In all patients, the mosaic enhancement pattern was diffuse, but more conspicuous in subcapsular areas. • MP was no longer seen after resolution of the acute disease. • No liver biopsy should be performed.
PURPOSE: To report the association of a mosaic enhancement pattern on contrast-enhanced CT or MR imaging and hepatic sinusoidal dilatation (SD) with acute inflammatory conditions affecting extrahepatic organs. METHODS: From 2007 to 2012, patients with acute inflammatory diseases who underwent contrast-enhanced CT and/or MRI of the liver with a mosaic enhancement pattern were selected. Clinico-biological and other imaging features were collected at diagnosis and during follow-up. RESULTS: Sixteen patients were included (15 women, median age 27 years; range 18-68). Five women (33 %) were receiving oral contraceptives. Acute inflammatory diseases included pyelonephritis (n = 10), pancreatitis (n = 2), pneumonia (n = 1), septicemia (n = 1), active Crohn's disease (n = 1), and infectious colitis (n = 1). Median white blood cell count was 13,250 cells/μL (range 11,500-18,000 cells/μL) and CRP level 94 mg/L (range 60-121 mg/L). Mosaic enhancement pattern was present in the whole liver and was prominent in the subcapsular areas. Four patients underwent liver biopsy confirming SD. Eleven patients underwent follow-up imaging showing normalized aspect in 9/11 patients after a median of 2 months. CONCLUSION: Acute diseases of extrahepatic organs, associated with a marked systemic inflammatory syndrome should be added to the list of conditions causing a reversible hepatic sinusoidal dilatation as manifested by a mosaic enhancement pattern on contrast-enhanced CT or MR imaging. KEY POINTS: • Acute extrahepatic infectious/inflammatory diseases are a cause of transient MP. • In most patients, MP was seen during both arterial and portal venous phase. • In all patients, the mosaic enhancement pattern was diffuse, but more conspicuous in subcapsular areas. • MP was no longer seen after resolution of the acute disease. • No liver biopsy should be performed.
Entities:
Keywords:
Computed tomography; Inflammation and infection; Magnetic resonance imaging; Mosaic enhancement pattern; Sinusoidal dilatation
Authors: J Y Scoazec; C Marche; P M Girard; J Houtmann; A M Durand-Schneider; A G Saimot; J P Benhamou; G Feldmann Journal: Am J Pathol Date: 1988-04 Impact factor: 4.307
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