Diagnostic Dilemma - Pediatric Oncall
Author: Pediatric Oncall
An 8 months old boy was diagnosed as hepatoblastoma at 4 months of age for which he underwent chemotherapy {4 cycles of PLADO regimen} and subsequently underwent right sided extensive hepatic resection at 8 months of age. Pre-operatively his LFT are shown in Table 1. Post operatively, in 24 hours, his LFT are depicted in Table 1 which shows marked elevation of liver transaminases with jaundice. He continued to have hemorrhagic ascitis though ascitic fluid cytospin was negative for malignant cells. He did have prolonged inferior vena clamping during intra operative period. He subsequently died after 6 days post operative.
Answers of this discussion
Author :- Manini Moudgal on 01 August 2013.
Answer :- Prolonged clamping causing ischemia { high transaminases} and liver failure { jaundice and raised PT, PTT}.

Author :- arvind sood on 02 August 2013.
Answer :- ishemia of liver

Author :- drnirmala singh on 05 August 2013.
Answer :- acute liver failure due to ischemia.

Author :- shahad smaesim on 07 August 2013.
Answer :- The harmorrhage{haemorrhagic ascitis}

Author :- Rolando Lezama on 12 August 2013.
Answer :- hepatic necrosis

Author :- arvind sood on 17 August 2013.
Answer :- Ischemia of liver

Author :- HanumanthaRao K.R on 22 August 2013.
Answer :- acute hepatocellular failure due to massive resection and prlonged clamping leading to ascites due to venous congestion. and diagnosis to be revised whether it is Haemangioblastoma or hepatoblastoma

Author :- Krishna Sen on 24 August 2013.
Answer :- Acute Hepatic necrosis

Author :- Gonzalez Granado on 25 August 2013.
Answer :- Acute liver failure due to ischemia. Raised LDH might support the diagnosis

Author :- Nopporn Apiwattanakul on 25 August 2013.
Answer :- Veno occlusive disease at posthepatic level

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