[Veno-occlusive liver disease after total infradiaphragmatic lymphoid irradiation. A rare complication].
BACKGROUND
Radiotherapy is potentially curative in early stages of follicle center lymphoma. Frequent side effects are pancytopenia, nausea and abdominal discomfort. A radiation-induced liver injury with serious clinical symptoms and changes in liver function is a rare complication.


METHODS
Whole abdomen was irradiated in a 49-year-old patient with a centrocytic-centroblastic lymphoma, stage IA (localization: left inguinal region). A total dose of 30 Gy was delivered in a weekly fractionation of five times 1.5 Gy. Kidneys were protected by shielding after a dose of 13.5 Gy, liver blocks were positioned after 25 Gy. During the last 2 days of therapy the patient presented with weight gain, ascites, dyspnoea and elevated liver enzymes. Diagnostics revealed hepatosplenomegaly, ascites and an increased portosystemic pressure gradient. Liver biopsy specimen showed a veno-occlusive disease. Complete relief of symptomatology was achieved within 7 days following placement of a transjugular intrahepatic portosystemic stent-shunt (TIPSS), heparinization and diuretics. Liver enzymes are in the normal range.


CONCLUSIONS
Veno-occlusive disease of the liver (VOD) is a very rare side effect of primary abdominal irradiation of follicle center lymphoma. This complication should be taken into consideration if a patient presents with upper right quadrant pain, ascites and elevation of liver enzymes especially within 4 months following radiotherapy. Genesis of veno-occlusive disease, diagnostics, therapy and a review of the literature are presented.
Bischof
M
M
Abteilung für Klinische Radiologie-Schwerpunkt Strahlentherapie-Radiologische Klinik, Universität Heidelberg. marc_bischof@med.uni-heidelberg.de
Zierhut
D
D
Gutwein
S
S
Hansmann
J
J
Stremmel
W
W
Müller
M
M
Wannenmacher
M
M
D000792:Angiography; D001201:Ascites / Q000209:etiology; D017024:Chemotherapy, Adjuvant; D003964:Diaphragm; D019583:Dose Fractionation, Radiation; D006119:Groin; D006801:Humans; D008099:Liver / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000201:enzymology; D008102:Liver Circulation / Q000528:radiation effects*; D015182:Lymphatic Irradiation / Q000009:adverse effects* / Q000379:methods*; D008224:Lymphoma, Follicular / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D018714:Radiotherapy, Adjuvant; D014057:Tomography, X-Ray Computed; D014689:Venous Insufficiency / Q000150:complications / Q000209:etiology* / Q000601:surgery