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Significance of magnetic resonance imaging in the diagnosis of nodular regenerative hyperplasia of the liver complicated with systemic lupus erythematosus: a case report and review of the literature

Department of Medicine II, Hokkaido University School of Medicine, N-15, W-7, Kita-ku, Sapporo 060-8638, Japan thorita{at}med.hokudai.ac.jpDepartment of Medicine II, Hokkaido University School of Medicine, Sapporo, Japan

A Tsutsumi

Department of Medicine II, Hokkaido University School of Medicine, Sapporo, Japan; Division of Rheumatology, Department of Internal Medicine, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan

T Takeda

Department of Medicine III, Obihiro Kousei Hospital, Obihiro, Japan

S Yasuda

R Takeuchi

Y Amasaki

K Ichikawa

T Atsumi

T Koike

Department of Medicine II, Hokkaido University School of Medicine, Sapporo, Japan

Nodular regenerative hyperplasia of the liver (NRH), characterized by multiple hepatic nodules in the absence of fibrosis, is a rare but important complication of systemic lupus erythematosus (SLE) associated with non-cirrhotic portal hypertension. The diagnosis of NRH is based on the pathological examination, and radiological findings of NRH are poorly documented. We report a case of a 40-year-old woman with SLE complicated with NRH. Sixteen years after diagnosis of SLE, esophageal varices were incidentally found and diagnosis of portal hypertension due to NRH was made by magnetic resonance imaging (MRI) and confirmed by needle liver biopsy. Although MRI showed the lesions as significant nodules, neither computed tomography nor ultrasonography could demonstrate the nodules. However, serial MRI showed significant enlargement of the nodules for 2 years Because NRH may lead to portal hypertension with life-threatening variceral haemorrhage in patients with SLE, MRI is a useful, non-invasive examination to screen the patients for its presence and follow-up. We reviewed the literature regarding NRH in SLE and discuss the management of the affected patients.

Key Words: nodular regenerative hyperplasia • portal hypertension • magnetic resonance imaging • systemic lupus erythematosus

Lupus, Vol. 11, No. 3, 193-196 (2002)
DOI: 10.1191/0961203302lu164cr


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