[Clinical characteristics of hepatic sinusoidal obstruction syndrome: analysis of 8 cases].
OBJECTIVE
To investigate the diagnosis and treatment of sinusoidal obstruction syndrome (SOS).


METHODS
The data of 8 patients with SOS, including clinical manifestations, laboratory results, imaging, pathology, and the course of diagnosis and treatment were reviewed. All cases were followed up.


RESULTS
The main clinical manifestations included abdominal distention, hepatalgia and signs of ascites and hepatomegaly. There were mild or moderate hepatocellular injury in 6 patients and heavy injury in 2. All patients' serum-ascites albumin gradient exceeded 11.1 g/L. The levels of CA125 in both serum and ascites elevated significantly. All patients' ultrasonography showed hepatomegaly, appearance of portal hypertension and attenuated hepatic veins. Reverse blood flow in portal vein was observed in 5 cases. Magnetic resonance imaging showed that contrast agent accumulated unevenly in liver in both portal period and lag period, but filled poorly in hepatic veins. Per cutsem liver biopsy showed that all patients' hepatic sinusoids were congested, but venular occlusion was observed in only 3 cases. Five cases had been misdiagnosed. One patient healed after liver transplantation, 4 patients recovered gradually by treatment with heparin and so on and 3 patients died.


CONCLUSIONS
Signs of outstanding portal hypertension with mild hepatocellular injury is the main clinical feature of SOS. Both serum and ascites CA125 levels in SOS patients are elevated significantly. The misdiagnosis rate of SOS is quite high, ultrasonography and magnetic resonance imaging have significant value in diagnosis and differential diagnosis, while the value of per cutsem liver biopsy is limited. Combination of imaging and pathology should contribute to correct diagnosis of SOS. Application of anticoagulant in early course is vital, liver transplantation should be considered in severe cases.
Chen
Hong-tan
HT
Department of Gastroenterology, The First Affiliated Hospital, Medical School of Zhejiang University, Hangzhou 310003, China.
Xu
Guo-qiang
GQ
Li
You-ming
YM
Liu
You-Shi
YS
Yu
Chao-hui
CH
Zhong
Bai-shu
BS
Zheng
Zhe-lan
ZL
Jiang
Tian-an
TA
Chen
Chun-xiao
CX
Gu
Zhu-ying
ZY
Ren
Guo-ping
GP
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006504:Hepatic Veno-Occlusive Disease / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies