%0 Journal Article
%T Embolization of Cyanoacrylate glue in systemic circulation in a case of hepatocellular carcinoma: an autopsy report
%A Kirti Gupta
%A Rakesh K Vasishta
%A Usha Dutta
%A Rakesh K Kochhar
%A Kartar Singh
%J Diagnostic Pathology
%D 2009
%I BioMed Central
%R 10.1186/1746-1596-4-45
%X A 77 year-old lady presented four years back with upper gastrointestinal bleed. On examination, she had splenomegaly and grade three esophageal and fundal varices. Ultrasound abdomen had revealed a shrunken liver with coarse echotexture, portal vein (15 mm), splenomegaly, ascites and collateral formation at gastrohepatic ligament. Viral markers [anti-Hepatitis C virus (anti-HCV) and hepatitis B surface antigen (HBsAg)] were negative. Ascitic fluid examination revealed a total cell count of 80 (all lymphocytes), protein 300 mg/dL, sugar 134 mg/dl, SAAG 2.5. She was diagnosed as a case of decompensated cirrhosis with portal hypertension, ascites, upper gastrointestinal bleed, and hepatic encephalopathy. She was discharged on oral hematinics, Propranolol, diuretics and Lactulose. She underwent several sessions of variceal ligation, endoscopic sclerotherapy for esophageal varices. She also underwent 2 sessions of cyanoacrylate glue injection (1.5 ml each time) for large fundal varices. A year later, she developed persistent pruritis. Autoimmune work-up revealed anti-nuclear antibody (ANA) 3+, other autoimmune markers [(anti-smooth muscle autoantibody (SMA), anti-liver/kidney microsome antibody (LKM) and anti-mitochondrial antibody (AMA)] were negative. The liver biopsy was deferred in view of persistent deranged coagulation profile. She was started on Azathioprine (50 mg) which had to be stopped after 9 months because of persistent elevation of liver enzymes (aspartate aminotransferase (AST) - 100 IU/L, alanine transaminase (ALT) - 56 IU/L and alkaline phosphatase (ALP) - 622 IU/L) suggestive of Azathioprine induced cholestatic hepatitis. On subsequent follow up, her AST and ALT values normalized on stoppage of the drug.She was now hospitalized, after 4 years, with symptoms of pleuritic chest pain for 2 weeks, with associated dyspnoea and orthopnea. She also had malena for two days about a week ago. She had pallor, icterus, peripheral cyanosis and bilateral pedal edema
%U http://www.diagnosticpathology.org/content/4/1/45