HELLP syndrome

Großes

subkapsuläres Hämatom der Leber bei einer Frau mit HELLP-Syndrom.

Subcapsular

liver haematoma: a rare complication of HELLP syndrome. Ultrasound of liver shows a hypoechoic subcapsular lentiform mass paralleling the right hepatic lobe (arrow).

www.eurorad.org • CC by-nc-sa-4.0

Subcapsular

liver haematoma: a rare complication of HELLP syndrome. A contrast-enhanced CT shows a hypodense subcapsular collection of the right hepatic lobe repressing the parenchyma without perfusion disorders: Subcapsular liver heamatoma.

www.eurorad.org • CC by-nc-sa-4.0

Subcapsular

liver haematoma: a rare complication of HELLP syndrome. Axial and coronal reformatted enhanced CT 15 days postpartum shows a discrete regression of the subcapsular liver haematoma.

www.eurorad.org • CC by-nc-sa-4.0

HELLP

syndrome • HELLP syndrome with hepatic artery embolization following spontaneous hepatic rupture and hemorrhage - Ganzer Fall bei Radiopaedia

Walker, N. HELLP syndrome with hepatic artery embolization following spontaneous hepatic rupture and hemorrhage. Case study, Radiopaedia.org. (accessed on 11 Nov 2022) https://doi.org/10.53347/rID-97336 • CC by-nc-sa 3.0 (modified)

HELLP

syndrome • Hepatic infarction in HELLP - Ganzer Fall bei Radiopaedia

Keene, J. Hepatic infarction in HELLP. Case study, Radiopaedia.org. (accessed on 11 Nov 2022) https://doi.org/10.53347/rID-51696 • CC by-nc-sa 3.0 (modified)

HELLP

syndrome • Hepatic infarct complicating HELLP syndrome - Ganzer Fall bei Radiopaedia

Sakhy Y, Hepatic infarct complicating HELLP syndrome. Case study, Radiopaedia.org (Accessed on 27 Jan 2023) https://doi.org/10.53347/rID-159064 • CC by-nc-sa 3.0 (modified)

Radiopaedia • CC-by-nc-sa 3.0 • de

HELLP syndrome is a pregnancy-related condition and is an abbreviation for:

haemolysis
elevated liver enzymes and
low platelets

It is considered a severe and life-threatening form of pre-eclampsia although it can occur without co-existing pre-eclampsia.

Epidemiology

The estimated incidence is ~0.5% (range 0.17-0.85%) of live births . The condition often occurs in the 3 trimester of pregnancy (and postpartum ). It tends to present in young primigravid women.

Clinical presentation

The presentation can be variable and can include malaise, epigastric/right upper quadrant pain, and nausea/vomiting. Some may have non-specific viral-like symptoms. Hypertension and proteinuria (classic symptoms of preeclampsia) may be absent or slight .

Pathology

The etiology and pathophysiology remain incompletely understood with multiple theories :

immune-mediated: maternal acute rejection reaction to fetal antigens
placenta-mediated liver injury
systemic inflammatory response syndrome in the setting of pre-eclampsia

Histology

On liver histology, there is a combination of deposited fibrin, hemorrhage, and hepatocellular necrosis surrounding portal areas .

Complications

disseminated intravascular coagulation: reported to occur in ~30% (range 20-40%) of patients
hepatic infarction
hepatic hematoma
hepatic rupture
placental abruption

Radiographic features

General features predominantly involve hepatic sequelae:

hepatomegaly: especially the right lobe
hemorrhage, subcapsular hematoma, rupture
hepatic infarction

Ultrasound

Generally preferred over CT, an ultrasound is usually preferred to avoid ionizing radiation.

CT

The place of CT is mainly to assess for complications. When considering a CT scan the radiologist needs to discuss with the obstetrician regarding radiation risk to fetus from radiation, versus clinical suspicion of complications in order to make a rational judgment. The CT scan may show hepatic complications as described above.

Treatment and prognosis

Management is often supportive. Patients with hepatic rupture +/- intraperitoneal bleeding require immediate surgery or selective hepatic arterial embolization.