A 63-year-old ex-smoker, asymptomatic patient attended our hepatology service in July 2001 due to an ex-smoker (from 4 cm to an ex-site of the hepatic lobule) and an alkaline varstasis (GTpeptia)
The other parameters, including ANA (antinuclear antibodies), AMA (antimitochondrial antibodies), ASMA (anti-smooth muscle antibodies), AMA (antimyochondrial antibodies), hepatitis C virus (antigen deficiency, anti-HBV), and hepatitis C virus negative (antigen antibodies, anti-human microglobulin, anti-HBV), and hepatitis C virus anti-HBV antibodies, anti-HBV antibodies, anti-HB
In the study of immunoglobulins stood out IgG 1900 mg/dl (690-1400), in relation to monoclonal gammopathy without myeloma data after bone marrow study.
The study of prothrombotic diathesis was also negative.
The ultrasound study did not provide relevant data.
Abdominal computed tomography (CT) revealed a hypodense subdiaphragmatic lesion in segments VIII and IV with poorly defined contour on both sides of the middle suprahepatic vein.
Hepatic magnetic resonance imaging (MRI) revealed two hepatic lesions measuring 3 × 3 cm and 3 × 2 cm, in segments IV-VIII and II-III respectively, which fitted the right suprahepatic vein with non-obstructive suprahepatic bile lobe and displacement.
When a cholangiocarcinoma is suspected and less likely a hepatocarcinoma develops over a non-cirrhotic liver, the patient undergoes a pathologous biopsy (aspiration-pancreatization with a characteristic appearance).
The intraoperative histopathological report of a fibro-lymphoid process confirmed the presence of aggregate, vascular hyalinization, in the absence of microorganisms and atypia, with a hepatic inflammatory pseudotumor.
Since the lesion did not meet criteria for malignancy and given the high morbidity and mortality associated, resection was ruled out and antibiotic and steroid treatment was started, with no response.
In January 2006, the patient presented an episode of self-limiting upper gastrointestinal bleeding, followed by fever, asthenia, hypoxia and behavior alteration.
On physical examination, subicterus-mucosapping, cutaneous sepsis, late flail, hepatomegaly and ascites were observed.
Analytically there was evidence of chronic process anaemia (haemoglobin 9.1 g/dl, haematocrit IU conjugate VOTCM 95), mild thrombocytopenia (116.000), total bilirubin 4.3 mg/dl (see
Gamma 30.7% (10.5-19.5), leukocytes 7,700 and 800 lymphocytes.
Ascitic fluid analysis revealed 900 cells (> 250 polymorphonuclear cells/mm3), albumin 0.5 g/dl, total protein 0.6 g/dl, GASA > 1.1, and negative culture.
With the diagnosis of bacterial peritonitis antibiotic treatment was initiated (third generation cephalosporin) with good clinical and analytical response.
Gastroscopy showed esophageal varices grade II/III, beginning beta-blocker treatment.
A new MRI was performed, describing a liver with signs of chronic liver disease and how the ITP compressed and collapsed the inferior vena cava in its intrahepatic course.
With the diagnosis of subacute Budd-Chiari syndrome secondary to liver ITP, we placed a TIPS (transjugular portosystemic anastomosis type Wallstent self-expandable five-year follow-up).
