Abstract

BACKGROUND: Isolated hepatic artery thrombosis is an extremely rare disorder with only few cases reported in literature.

CASE REPORT: A 62-year-old female presented with five days of right upper quadrant pain, nausea and vomiting. Her physical exam was remarkable for right upper quadrant tenderness to palpation. Her initial laboratory work was significant for elevated aspartate aminotransferase, alanine aminotransferase (745 and 431 U/L respectively), compared to normal levels on a routine blood work done two days prior to admission. A computed tomography with administration of oral and intravenous contrast showed a thrombus within the hepatic artery with multiple hepatic infarcts; no portal vein thrombosis was noted. Hypercoagulabilty workup was unremarkable, she did not have any evidence of atrial fibrillation on ECG or telemetry. Over the following few days, AST and ALT levels continued to rise up to 2065 and 1217 U/L respectively on day five, and started to trend down after. However, Discussion: Hepatic infarcts following hepatic artery compromise are very rare because of the dual blood supply to the liver, along with the extensive hepatic arterial collateral system. The vast majority of cases of hepatic artery thrombosis are reported as complications of orthotopic liver transplantation; it also complicates various procedures.

CONCLUSIONS: We believe that our case is unique because of two reasons: 1.) Our patient did not undergo any procedure that may have precipitated hepatic artery thrombosis. 2.) Despite the absence of concurrent portal vein thrombosis, she had biochemical and imaging findings of hepatic ischemia.

Keywords: Diagnosis, Differential, Angiography, Electrocardiography, Hepatic Artery, Infarction - etiology, Liver - blood supply, Thrombosis - diagnosis, Tomography, X-Ray Computed