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From question on page 957
The diagnosis is liver, spleen and renal infarction caused by bacterial endocarditis. The patient had infarctions involving multiple organs including the brain, liver, spleen and kidney, suggesting the presence of cardiogenic embolism. Echocardiography confirmed the presence of mitral valve vegetation and four sets of blood cultures yielded Staphylococcus aureus. Despite antibiotic therapy, the patient died of multiple organ failure 1 week after admission.
Unlike splenic and renal infarction, infarction of the liver is rare and is usually diagnosed at autopsy before the wide use of cross‐sectional image modalities such as CT or MRI. A common cause of liver infarction is hepatic artery thrombosis following transplantation, hepatic artery injury during laparoscopic cholecystectomy, hepatic artery disruption during motor vehicle injury or complications following transcatheter embolisation of hepatic tumours. Rarely, pre‐eclampsia, shock or polyarteritis nodosa have been reported as a rare cause of liver infarction. Infarctions involving multiple organs in this case lead to the diagnosis of endocarditis despite its atypical presentation. Patients with liver infarction may have abdominal pain, fever, chills or abnormal liver function. Ultrasound examination of the liver may show poorly defined inhomogeneous or hypoechoic zones. CT scan typically discloses a well‐circumscribed, peripheral and wedge‐shaped lesion. Management of liver infarction requires correction of the underlying disease. Serial CT or ultrasound examinations are usually required to monitor its regression or treat infectious complications.