Hepatic imaging in HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count).
OBJECTIVE
Our objective was to describe the hepatic imaging findings in selected patients with HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) and to correlate these findings with the severity of concurrent clinical and laboratory abnormalities.


METHODS
Patients with laboratory criteria for HELLP syndrome with complaints of severe right upper quadrant abdominal pain in association with either shoulder pain, neck pain, or relapsing hypotension underwent imaging of the liver. Clinical and laboratory parameters were then correlated with the hepatic imaging findings.


RESULTS
Thirty-four patients were evaluated in this study. Computed tomographic scanning of the liver was used for 33 patients. Additional imaging evaluations included magnetic resonance imaging for 4 patients and ultrasonographic evaluation of the liver for 5 patients. In 15 cases (45%) the computed tomographic results were abnormal. The most frequent abnormal hepatic imaging findings were subcapsular hematoma (n = 13) and intraparenchymal hemorrhage (n = 6). There was no statistically significant correlation between the presence of an abnormal hepatic imaging finding and the severity of liver function test abnormalities. However, the severity of thrombocytopenia did correlate with hepatic imaging findings (p = 0.04). In particular, an abnormal hepatic imaging finding was noted for 10 of 13 patients (77%) with a platelet count of < or = 20 x 10(9)/L (p = 0.012).


CONCLUSIONS
Abnormalities in liver function test results do not accurately reflect the presence of abnormal hepatic imaging findings in HELLP syndrome. Patients with HELLP syndrome having complaints of right upper quadrant pain and neck pain, shoulder pain, or relapsing hypotension should undergo imaging of the liver.
Barton
J R
JR
Department of Obstetrics and Gynecology, Central Baptist Hospital, Lexington, Kentucky, 40503, USA.
Sibai
B M
BM
D000293:Adolescent; D000328:Adult; D005260:Female; D017359:HELLP Syndrome / Q000000981:diagnostic imaging / Q000473:pathology*; D006406:Hematoma / Q000473:pathology; D006470:Hemorrhage / Q000473:pathology; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology*; D008107:Liver Diseases / Q000473:pathology; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D013921:Thrombocytopenia / Q000473:pathology; D014463:Ultrasonography