Hepatic Artery Thrombosis

 Results in bile duct ischemia, hepatic parenchymal infarction


– Bile ducts depend on arterial flow and therefore suffer ischemic injury





Clinical Issues




• Relatively well tolerated in native livers
image Anastomosing blood supply with good collateralization protects against ischemic injury

• Transplanted livers much more susceptible, especially early post transplant

• Symptoms related to acuity and ensuing complications

• Cholestatic liver function abnormalities are common


Microscopic




• Zone 3 hemorrhage and hepatocyte dropout in early posttransplant period
• Ischemic bile duct injury

image Denuded, necrotic bile duct epithelium sloughs into lumen, forming eosinophilic bile casts

image Bile leakage into periductal connective tissue

image In time, chronic ischemia can lead to biliary strictures, fibrosis, and duct loss

• Hepatic infarction
image Necrosis of hepatocytes and portal connective tissue


Diagnostic Checklist




• Needle biopsy may not be representative, as ischemic features may be patchy

image
Hepatic Infarction
This section demonstrates a well-delineated area of hepatic parenchymal infarction image following hepatic artery thrombosis.


image
Abscess Due to Bile Duct Necrosis and Leak
An explanted allograft liver demonstrates an area of bile duct necrosis and a bile leak image in a patient who developed hepatic artery thrombosis after transplantation.

image
Bile Duct Necrosis and Leak
This large bile duct has suffered ischemic necrosis image and leakage of bile image. The bile duct ischemia occurred secondary to hepatic artery thrombosis.

image
Zone 3 Hemorrhage and Hepatocyte Dropout
Cases of hepatic artery thrombosis may feature nonspecific zone 3 hemorrhage, inflammation, and hepatocyte dropout, particularly early in the posttransplant course. These changes can mimic reperfusion injury.


TERMINOLOGY


Abbreviations




• Hepatic artery thrombosis (HAT)


Definitions




• Thrombotic occlusion of hepatic artery &/or its branches


ETIOLOGY/PATHOGENESIS


Causes of Thrombosis



Apr 20, 2017 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Hepatic Artery Thrombosis

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