Published online May 27, 2018. doi: 10.4254/wjh.v10.i5.417
Peer-review started: February 3, 2018
First decision: March 8, 2018
Revised: April 23, 2018
Accepted: May 11, 2018
Article in press: May 11, 2018
Published online: May 27, 2018
To characterize isolated non-obstructive sinusoidal dilatation (SD) by identifying associated conditions, laboratory findings, and histological patterns.
Retrospectively reviewed 491 patients with SD between 1995 and 2015. Patients with obstruction at the level of the small/large hepatic veins, portal veins, or right-sided heart failure were excluded along with history of cirrhosis, hepatic malignancy, liver transplant, or absence of electrocardiogram/cardiac echocardiogram. Liver histology was reviewed for extent of SD, fibrosis, red blood cell extravasation, nodular regenerative hyperplasia, hepatic peliosis, and hepatocellular plate atrophy (HPA).
We identified 88 patients with non-obstructive SD. Inflammatory conditions (32%) were the most common cause. The most common pattern of liver abnormalities was cholestatic (76%). Majority (78%) had localized SD to Zone III. Medication-related SD had higher proportion of portal hypertension (53%), ascites (58%), and median AST (113 U/L) and ALT (90 U/L) levels. Nineteen patients in our study died within one-year after diagnosis of SD, majority from complications related to underlying diseases.
Significant proportion of SD and HPA exist without impaired hepatic venous outflow. Isolated SD on liver biopsy, in the absence of congestive hepatopathy, requires further evaluation and portal hypertension should be rule out.
Core tip: We identified 88 patients with diagnosis of non-obstructive sinusoidal dilatation (SD) over the period of twenty years. Inflammatory conditions (32%) were the most common cause identified. Medication related SD was associated with higher proportion of portal hypertension, ascites, and elevated transaminases. The finding of non-obstructive SD on liver biopsy should prompt a review of patient’s medical history and drug exposure. Additionally, portal hypertension should be rule out either clinically, endoscopically, or radiographically. There does not appear to be any relationship between histological patterns and medical conditions, which may suggest overlapping biological pathways in the development of non-obstructive sinusoidal dilatation.