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Abdominal Imaging Features of HELLP Syndrome: A 10-Year Retrospective Review

¹ All authors: Department of Radiology, Virginia Commonwealth University/Medical College of Virginia Hospitals and Physicians, 1101 E Marshall St., Sanger Hall, Rm. 4-050, PO Box 980470, Richmond, VA 23298-0470.

View larger version (126K): [in a new window]   Fig. 1A —38-year-old woman with HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome and liver rupture (patient 1 in Table 1). Transverse sonogram of liver shows intraparenchymal hematoma (H) that is hypoechoic relative to uninvolved liver (L) and isoechoic relative to adjacent perihepatic hematoma (asterisks).

View larger version (136K): [in a new window]   Fig. 1B —38-year-old woman with HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome and liver rupture (patient 1 in Table 1). Contrast-enhanced CT scan obtained at level similar to A reveals low-attenuation hematoma (H) in right hepatic lobe is isoattenuating to perihepatic hematoma (asterisks). Irregular interface between intraparenchyma and perihepatic hematoma presumably represents site of rupture.

View larger version (138K): [in a new window]   Fig. 1C —38-year-old woman with HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome and liver rupture (patient 1 in Table 1). Contrast-enhanced CT scan obtained 3.2 cm cephalad to B shows that hematoma involves medial segment of left hepatic lobe (M) and most of right hepatic lobe.

View larger version (142K): [in a new window]   Fig. 1D —38-year-old woman with HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome and liver rupture (patient 1 in Table 1). Contrast-enhanced CT scans of lower abdomen (D) and pelvis (E) reveal hemoperitoneum (asterisk) with in vivo hematocrit effect (arrow) in right paracolic gutter and pelvic cul-de-sac, respectively.

View larger version (133K): [in a new window]   Fig. 1E —38-year-old woman with HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome and liver rupture (patient 1 in Table 1). Contrast-enhanced CT scans of lower abdomen (D) and pelvis (E) reveal hemoperitoneum (asterisk) with in vivo hematocrit effect (arrow) in right paracolic gutter and pelvic cul-de-sac, respectively.

View larger version (150K): [in a new window]   Fig. 1F —38-year-old woman with HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome and liver rupture (patient 1 in Table 1). Conventional celiac angiogram shows multiple small hemorrhages (arrows) associated with peripheral branches of right hepatic artery and larger hemorrhage (arrowheads) in dome of liver.

View larger version (135K): [in a new window]   Fig. 1G —38-year-old woman with HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome and liver rupture (patient 1 in Table 1). Conventional celiac angiogram obtained after embolization with gelatin sponge (Gelfoam, Upjohn) and polyvinyl alcohol-soaked sponges reveals complete resolution of hemorrhage. Minor degree of vasospasm is present and is likely related to patient's hypovolemic state.

View larger version (134K): [in a new window]   Fig. 2A —33-year-old woman with HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome and liver rupture (patient 2 in Table 1). Transverse sonogram of liver shows heterogeneity (H), which is representative of hematoma, involves right hepatic lobe and medial segment of left. Perihepatic hematoma (asterisk) is slightly hypoechoic relative to liver.

View larger version (120K): [in a new window]   Fig. 2B —33-year-old woman with HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome and liver rupture (patient 2 in Table 1). Sagittal sonogram of liver reveals perihepatic hematoma (asterisk) is slightly hypoechoic relative to adjacent liver.

View larger version (156K): [in a new window]   Fig. 2C —33-year-old woman with HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome and liver rupture (patient 2 in Table 1). Unenhanced CT scan of liver shows high-attenuation perihepatic hematoma (asterisks) adjacent to unenhanced liver (L).

View larger version (141K): [in a new window]   Fig. 2D —33-year-old woman with HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome and liver rupture (patient 2 in Table 1). Contrast-enhanced CT scan obtained at level similar to C reveals multifocal low-attenuation intraparenchymal hematomas (H) involving right hepatic lobe and medial segment of left. Perihepatic hematomas (asterisks) are again noted.

View larger version (141K): [in a new window]   Fig. 2E —33-year-old woman with HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome and liver rupture (patient 2 in Table 1). Contrast-enhanced CT scan obtained 3 cm caudad to D shows multifocal intraparenchymal hematomas (H), perihepatic hematoma (asterisk), and hemoperitoneum (arrow).

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