Differential Diagnosis for Acute Liver Ischemia
Single Most Likely Diagnosis
- Hepatic Artery Thrombosis: This is a common cause of acute liver ischemia, especially in patients with pre-existing liver disease or those who have undergone liver transplantation. The hepatic artery is responsible for supplying oxygenated blood to the liver, and thrombosis can lead to ischemia.
Other Likely Diagnoses
- Hepatic Vein Thrombosis (Budd-Chiari Syndrome): This condition involves thrombosis of the hepatic veins, which can cause liver ischemia due to impaired blood flow out of the liver.
- Portal Vein Thrombosis: Thrombosis of the portal vein can also lead to liver ischemia, particularly if the thrombosis is extensive and involves the hepatic artery or other branches.
- Shock or Hypoperfusion: Systemic hypoperfusion, such as in shock, can lead to reduced blood flow to the liver, resulting in ischemia.
Do Not Miss Diagnoses
- Hepatic Artery Aneurysm Rupture: Although less common, rupture of a hepatic artery aneurysm can cause acute liver ischemia and is a life-threatening condition that requires immediate attention.
- Embolic Events: Emboli originating from the heart or other sources can lodge in the hepatic artery, causing ischemia. This is particularly concerning in patients with a history of atrial fibrillation or other cardiac conditions.
Rare Diagnoses
- Vasculitis: Certain types of vasculitis, such as polyarteritis nodosa, can affect the hepatic artery and cause ischemia.
- Sickle Cell Disease: In patients with sickle cell disease, sickling of red blood cells can lead to vascular occlusion, including the hepatic artery, resulting in ischemia.
- Paroxysmal Nocturnal Hemoglobinuria (PNH): This rare condition can increase the risk of thrombosis, including in the hepatic veins, leading to ischemia.