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Peliosis Hepatis

By Nicholas T. Orfanidis, MD, Clinical Assistant Professor, Thomas Jefferson University Hospital

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Peliosis hepatis is typically an asymptomatic disorder in which multiple blood-filled cystic spaces develop randomly in the liver.

Measuring a few millimeters to about 3 cm in diameter, the cysts of peliosis hepatis often lack a cell lining and are surrounded by hepatocytes. Some have an endothelial cell lining, accompanied by dilated hepatic sinusoids. The cause is probably damage to the sinusoidal lining cells. Peliosis hepatis is associated with use of hormones (eg, anabolic steroids, oral contraceptives, glucocorticoids), tamoxifen, vinyl chloride, vitamin A, and, particularly in kidney transplant recipients, azathioprine.

Peliosis hepatis is usually asymptomatic, but occasionally cysts rupture, resulting in hemorrhage and sometimes causing death. Some patients develop overt liver disease, characterized by jaundice, hepatomegaly, and liver failure.

Mild cases may be detected incidentally during imaging tests done because liver function test results are slightly abnormal or for other reasons. Ultrasonography or CT can detect cysts. Most cases are not treated.

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