Peliosis hepatis overview: Difference between revisions
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==Pathophysiology== | ==Pathophysiology== | ||
The [[pathogenesis]] of peliosis hepatis is unknown. There are several [[Hypothesis|hypotheses]], such as, it arise from [[sinusoidal]] epithelial damage<ref>{{cite journal |author=Gushiken FC |title=Peliosis hepatis after treatment with 2-chloro-3'-deoxyadenosine |journal=South. Med. J. |volume=93 |issue=6 |pages=625-6 |year=2000 |pmid=10881786}}</ref>, increased sinusoidal pressure due to obstruction in blood outflow from the liver, or hepatocellular [[necrosis]]<ref name="marvin"/>. | The [[pathogenesis]] of peliosis hepatis is unknown. There are several [[Hypothesis|hypotheses]], such as, it arise from [[sinusoidal]] epithelial damage<ref>{{cite journal |author=Gushiken FC |title=Peliosis hepatis after treatment with 2-chloro-3'-deoxyadenosine |journal=South. Med. J. |volume=93 |issue=6 |pages=625-6 |year=2000 |pmid=10881786}}</ref>, increased sinusoidal pressure due to obstruction in blood outflow from the liver, or hepatocellular [[necrosis]]<ref name="marvin" />. | ||
Two [[morphology (biology)|morphologic]] patterns of hepatic peliosis were described by Yanoff and Rawson <ref>{{cite journal |author=YANOFF M, RAWSON AJ |title=PELIOSIS HEPATIS. AN ANATOMIC STUDY WITH DEMONSTRATION OF TWO VARIETIES |journal=Archives of pathology |volume=77 |issue= |pages=159-65 |year=1964 |pmid=14088761}}</ref>. In the '''phlebectatic''' type, the blood-filled spaces are lined with [[endothelium]] and are associated with [[aneurysm|aneurism]]al dilatation of the central vein; in the '''parenchymal''' type, the spaces have no endothelial lining and they usually are associated with [[haemorrhagic]] [[parenchyma]]l [[necrosis]]. Some considers both pattern to be one process, initiated by focal [[necrosis]] of liver parenchyma observed in parenchymal type progressing into formation of [[fibrous]] wall and endothelial lining around [[haemorrhage]] of phebectatic type. [[Fibrosis]], [[cirrhosis]], regenerative nodules, and [[tumor|tumours]] may also be seen. | Two [[morphology (biology)|morphologic]] patterns of hepatic peliosis were described by Yanoff and Rawson <ref>{{cite journal |author=YANOFF M, RAWSON AJ |title=PELIOSIS HEPATIS. AN ANATOMIC STUDY WITH DEMONSTRATION OF TWO VARIETIES |journal=Archives of pathology |volume=77 |issue= |pages=159-65 |year=1964 |pmid=14088761}}</ref>. In the '''phlebectatic''' type, the blood-filled spaces are lined with [[endothelium]] and are associated with [[aneurysm|aneurism]]al dilatation of the central vein; in the '''parenchymal''' type, the spaces have no endothelial lining and they usually are associated with [[haemorrhagic]] [[parenchyma]]l [[necrosis]]. Some considers both pattern to be one process, initiated by focal [[necrosis]] of liver parenchyma observed in parenchymal type progressing into formation of [[fibrous]] wall and endothelial lining around [[haemorrhage]] of phebectatic type. [[Fibrosis]], [[cirrhosis]], regenerative nodules, and [[tumor|tumours]] may also be seen. | ||
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common causes include | common causes include | ||
*[[Corticosteriods]] | *[[Corticosteriods]] | ||
*Oral [[Contraceptives]] | *Oral [[Contraceptives]] | ||
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==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
The prevalence of Peliosis hepatis is approximately 0.2 percent of patients with pulmonary tuberculosis and about 22 percent in patients following renal transplant. It is most commonly associated with renal transplants. <ref> https://www.ncbi.nlm.nih.gov/books/NBK554470/</ref><ref>https://www.uptodate.com/contents/peliosis-hepatis#:~:text=The%20reported%20prevalence%20of%20peliosis,2%2C6%2C7%5D< | The prevalence of Peliosis hepatis is approximately 0.2 percent of patients with pulmonary tuberculosis and about 22 percent in patients following renal transplant. It is most commonly associated with renal transplants. <ref> <ref> https://www.ncbi.nlm.nih.gov/books/NBK554470/</ref><ref>https://www.uptodate.com/contents/peliosis-hepatis#:~:text=The%20reported%20prevalence%20of%20peliosis,2%2C6%2C7%5D<nowiki><ref>.</nowiki><nowiki><ref>.</nowiki> | ||
==Diagnosis== | ==Diagnosis== | ||
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===Imaging Findings=== | ===Imaging Findings=== | ||
[[Ultrasound]] appears non-specific, usually demonstrating an irregular hypoechoic region or mass,<ref name="pmid16037541">{{cite journal| author=Savastano S, San Bortolo O, Velo E, Rettore C, Altavilla G| title=Pseudotumoral appearance of peliosis hepatis. | journal=AJR Am J Roentgenol | year= 2005 | volume= 185 | issue= 2 | pages= 558-9 | pmid=16037541 | doi=10.2214/ajr.185.2.01850558 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16037541 }} </ref> and on [[Computerized Tomography]] (CT scan) shows multiple hypoattenuating lesions of variable size. Central bleeding may lead to areas of hyperattenuating and even [[dystrophic calcification]]. <ref> https://doi.org/10.1148/rg.287085067 | [[Ultrasound]] appears non-specific, usually demonstrating an irregular hypoechoic region or mass,<ref name="pmid16037541">{{cite journal| author=Savastano S, San Bortolo O, Velo E, Rettore C, Altavilla G| title=Pseudotumoral appearance of peliosis hepatis. | journal=AJR Am J Roentgenol | year= 2005 | volume= 185 | issue= 2 | pages= 558-9 | pmid=16037541 | doi=10.2214/ajr.185.2.01850558 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16037541 }} </ref> and on [[Computerized Tomography]] (CT scan) shows multiple hypoattenuating lesions of variable size. Central bleeding may lead to areas of hyperattenuating and even [[dystrophic calcification]].<ref> https://doi.org/10.1148/rg.287085067 | ||
/</ref>[[Magnetic resonance imaging]] (MRI) may typically show hypointense, hyperintense, or enhancement, usually centrifugal (from the center outward). [[Angiography]] may show hypervascularity with multiple vascular [[nodules]]. <ref> https://radiopaedia.org/articles/hepatic-peliosis?lang=us/</ref> | /</ref> [[Magnetic resonance imaging]] (MRI) may typically show hypointense, hyperintense, or enhancement, usually centrifugal (from the center outward). [[Angiography]] may show hypervascularity with multiple vascular [[nodules]]. <ref> https://radiopaedia.org/articles/hepatic-peliosis?lang=us/</ref> | ||
===Other Diagnostic Studies=== | ===Other Diagnostic Studies=== | ||
There are no other diagnostic studies associated with Peliosis Hepatis | |||
==Treatment== | ==Treatment== | ||
=== Medical Therapy === | ===Medical Therapy=== | ||
* Bacillary peliosis hepatitis (peliosis hepatis caused by ''Bartonella spp.'')<ref> {{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref> | |||
*Bacillary peliosis hepatitis (peliosis hepatis caused by ''Bartonella spp.'')<ref> {{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref> | |||
:*Preferred regimen (1): [[Clarithromycin]] 500 mg bid for 4 months | :*Preferred regimen (1): [[Clarithromycin]] 500 mg bid for 4 months | ||
:*Preferred regimen (6): [[Erythromycin]] 500 mg PO qid for 4 months | :*Preferred regimen (6): [[Erythromycin]] 500 mg PO qid for 4 months | ||
:*Preferred regimen (2): [[Doxycycline]] 100 mg PO bid for 4 months | :*Preferred regimen (2): [[Doxycycline]] 100 mg PO bid for 4 months | ||
*Special Consideration | *Special Consideration | ||
:*Severe disease | :*Severe disease | ||
::* Preferred regimen: [[Doxycycline]] 100 mg PO/IV bid for 4 months {{and}} [[Rifampin]] 300 mg PO bid for 4 months | ::*Preferred regimen: [[Doxycycline]] 100 mg PO/IV bid for 4 months {{and}} [[Rifampin]] 300 mg PO bid for 4 months | ||
===Surgery=== | ===Surgery=== | ||
| Line 94: | Line 80: | ||
===Prevention=== | ===Prevention=== | ||
== See Also == | ==See Also== | ||
*[[Polycystic Liver Disease]] | |||
*[[Polycystic Liver Disease]] | |||
*Solitary congenital cysts | *Solitary congenital cysts | ||
*[[Congenital hepatic fibrosis]] | *[[Congenital hepatic fibrosis]] | ||
Latest revision as of 15:11, 5 January 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Adenike Eketunde
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Overview
Peliosis Hepatis is an uncommon vascular condition characterised by randomly distributed multiple blood-filled cavities throughout liver. Size of the cavities usually ranges between a few millimetres to 3 cm in diameter[1]. In the past it was a mere histological curiosity occasionally found at autopsies but has been increasingly recognised with wide ranging conditions from AIDS to the use of anabolic steroids. It also occasionally affects spleen, lymph nodes, lungs, kidneys, adrenal glands, bone marrow and other parts of gastrointestinal tract.[2].
Peliosis hepatis is often erroneously written "peliosis hepatitis", despite its not being one of the hepatitides. The correct term arises from the Greek pelios, i.e. discoloured by extravasated blood, livid[3], and the Latinized Genitive case (hepatis[4]) of the Greek hepar, liver[5].
Historical Perspective
There is limited information about the historical perspective of Peliosis hepatis
Classification
There is no established system for the classification of Peliosis hepatis
Pathophysiology
The pathogenesis of peliosis hepatis is unknown. There are several hypotheses, such as, it arise from sinusoidal epithelial damage[6], increased sinusoidal pressure due to obstruction in blood outflow from the liver, or hepatocellular necrosis[1].
Two morphologic patterns of hepatic peliosis were described by Yanoff and Rawson [7]. In the phlebectatic type, the blood-filled spaces are lined with endothelium and are associated with aneurismal dilatation of the central vein; in the parenchymal type, the spaces have no endothelial lining and they usually are associated with haemorrhagic parenchymal necrosis. Some considers both pattern to be one process, initiated by focal necrosis of liver parenchyma observed in parenchymal type progressing into formation of fibrous wall and endothelial lining around haemorrhage of phebectatic type. Fibrosis, cirrhosis, regenerative nodules, and tumours may also be seen.
Causes
Peliosis hepatis may be caused by drugs, toxins, chronic wasting disease, malignancy, and infection. Peliosis Hepatitis may develop in individuals with renal or cardiac transplantation, but in about 20-50% of patients, they are no comorbidities.
common causes include
- Corticosteriods
- Oral Contraceptives
- Tuberculosis
- Malignancy particularly Hepatocellular Carcinoma
- Diabetes mellitus
- Necrotizing vasculitis
- Infection in AIDS, bacillary peliosis caused by Bartonella henselae and Bartonella quintana)
- Hematologic disorders. [8]
Differentiating Peliosis hepatis from Other Diseases
Peliosis hepatis must be differentiated from Hepatic Adenoma, Hemangioma, Focal Nodular Hyperplasia, Hepatic Abscess, Hypervascular Metastases, and Hepatocellular Carcinoma.[9] Polycystic liver disease, Congenital hepatic fibrosis, Solitary congenital cysts, Hydatid cyst, Von Meyenburg complexes, Caroli disease (type V choledochal cyst).[10]
Epidemiology and Demographics
The prevalence of Peliosis hepatis is approximately 0.2 percent of patients with pulmonary tuberculosis and about 22 percent in patients following renal transplant. It is most commonly associated with renal transplants.
Physical Examination
The condition is typically asymptomatic and is discovered following evaluation of abnormal liver function test. However, when severe it can manifest as jaundice, hepatomegaly, liver failure and haemoperitoneum.
Laboratory Findings
There are no diagnostic laboratory findings associated with Peliosis Hepatis
Imaging Findings
Ultrasound appears non-specific, usually demonstrating an irregular hypoechoic region or mass,[11] and on Computerized Tomography (CT scan) shows multiple hypoattenuating lesions of variable size. Central bleeding may lead to areas of hyperattenuating and even dystrophic calcification.[12] Magnetic resonance imaging (MRI) may typically show hypointense, hyperintense, or enhancement, usually centrifugal (from the center outward). Angiography may show hypervascularity with multiple vascular nodules. [13]
Other Diagnostic Studies
There are no other diagnostic studies associated with Peliosis Hepatis
Treatment
Medical Therapy
- Bacillary peliosis hepatitis (peliosis hepatis caused by Bartonella spp.)[14]
- Preferred regimen (1): Clarithromycin 500 mg bid for 4 months
- Preferred regimen (6): Erythromycin 500 mg PO qid for 4 months
- Preferred regimen (2): Doxycycline 100 mg PO bid for 4 months
- Special Consideration
- Severe disease
- Preferred regimen: Doxycycline 100 mg PO/IV bid for 4 months AND Rifampin 300 mg PO bid for 4 months
Surgery
Prevention
See Also
- Polycystic Liver Disease
- Solitary congenital cysts
- Congenital hepatic fibrosis
- Hydatid cyst
- Von Meyenburg complexes
- Caroli disease (type V choledochal cyst)
- Type IV choledochal cysts
References
- ↑ 1.0 1.1 Sleisenger, Marvin (2006). Sleisenger and Fordtran's Gastrointestinal and Liver Disease. Philadelphia: W.B. Saunders Company. ISBN 1416002456. Chapter 80
- ↑ Ichijima K, Kobashi Y, Yamabe H, Fujii Y, Inoue Y (1980). "Peliosis hepatis. An unusual case involving multiple organs". Acta Pathol. Jpn. 30 (1): 109–20. PMID 7361545.
- ↑ "Henry George Liddell, Robert Scott, A Greek-English Lexicon". Retrieved 2007-06-11.
- ↑ "Charlton T. Lewis, Charles Short, A Latin Dictionary". Retrieved 2007-07-02.
- ↑ "Henry George Liddell, Robert Scott, A Greek-English Lexicon". Retrieved 2007-07-02.
- ↑ Gushiken FC (2000). "Peliosis hepatis after treatment with 2-chloro-3'-deoxyadenosine". South. Med. J. 93 (6): 625–6. PMID 10881786.
- ↑ YANOFF M, RAWSON AJ (1964). "PELIOSIS HEPATIS. AN ANATOMIC STUDY WITH DEMONSTRATION OF TWO VARIETIES". Archives of pathology. 77: 159–65. PMID 14088761.
- ↑ https://www.ajronline.org/doi/10.2214/AJR.05.0167#:~:text=The%20cause%20of%20peliosis%20hepatis,chronic%20wasting%20diseases%20(e.g.%2C%20tuberculosis
- ↑ https://www.ajronline.org/doi/10.2214/AJR.05.0167#:~:text=The%20cause%20of%20peliosis%20hepatis,chronic%20wasting%20diseases%20(e.g.%2C%20tuberculosis
- ↑ https://www.ncbi.nlm.nih.gov/books/NBK554470/
- ↑ Savastano S, San Bortolo O, Velo E, Rettore C, Altavilla G (2005). "Pseudotumoral appearance of peliosis hepatis". AJR Am J Roentgenol. 185 (2): 558–9. doi:10.2214/ajr.185.2.01850558. PMID 16037541.
- ↑ https://doi.org/10.1148/rg.287085067 /
- ↑ https://radiopaedia.org/articles/hepatic-peliosis?lang=us/
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.