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QUIZ No. 25
A 50-year-old woman presented with abdominal pain and vomiting. She has a history of periampullary carcinoma for which a Whipple’s procedure was done, and she has completed 10 cycles of chemotherapy. Laboratory investigations were normal. CE-CT and MRI were performed for further evaluation. What is your diagnosis?
CT
CT
CT
Visitor No:
ANS – Chemotherapy-induced hepatic sinusoidal obstruction syndrome
Findings - Peripheral and patchy reticular & mosaic pattern of enhancement of the liver parenchyma.
Chemotherapy (Oxaliplatin, Cyclophosphamide, Busulfan, etc.)
↓
Toxic injury to sinusoidal endothelial cells
↓
Sinusoidal dilatation + congestion
↓
Perisinusoidal fibrosis
↓
Obstruction of small hepatic venules
↓
Clinical features:
Early
• Right upper quadrant pain -
Late :
• Hepatomegaly
• Ascites
• Features of portal hypertension
Imaging findings:
CT/MRI: Mosaic pattern of enhancement → sinusoidal dilatation
MRI (Hepatobiliary phase): Peripheral & patchy reticular hypointensity → characteristic of SOS.
MRI (DWI): Diffuse multiple hyperintensities → may suggest malignant sinusoidal infiltration
Additional: Periportal edema, hepatomegaly, ascites, splenomegaly, narrowing of hepatic veins.
Take home points
1. SOS should be suspected in patients on chemotherapy (especially oxaliplatin) with patchy liver changes and reticular enhancement pattern.
2. Key differentiator from metastases → no discrete focal masses and no mass effect.
P.S – Chemotherapeutic agent , oxaliplatin was used in this patien
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