Occlusion of the Hepatic Veins with Cirrhosis of the Liver

• DOI: 10.1136/adc.5.27.167
• Publication Date: 2008-12-22T20:26:39Z
• Authors: R. Hutchison; S. L. Simpson
• Keywords: Hepatic veins; Liver circulation

The case described below is of interest, not only because its rarity, but also the patient had been observed over a large number years.Primary carcinoma liver finally supervened, and absence ascites throughout illness was an unusual feature.The autopsy findings, pathological fact that occlusion hepatic veins rarely if ever occurs in non-syphilitic cirrhosis, have led us to present as one primary veins, with secondary fibrosis liver.Clinical report.The clinical records this extend years 1906 1929.The patient, Herbert B., first came under observation year 1906, being then 5 age.He family, there no reason suspect syphilitic taint, course these were pre-Wassermann days.The abdomen said very protuberant since he old, when seen enlarged down umbilicus, smooth firm palpation.The spleen at time felt.There jaundice nor ascites, though robust boy presented other signs disease.No diagnosis arrived at.Two later (1907) notes show 'becoming irregular' following it stated 'the edge now two finger-breadths above umbilicus can be felt finger-breadth costal margin.'By 1910 condition unchanged 1912, 11 noted same just felt.'His general health continued fair.There note his after until 1920, about fingerbreadth ribs 'rather firm'; could felt.He lost sight till September, 1929.He reached age 28 complained severe attacks epigastric pain which recently begun trouble him along some decline health.Examination showed man rather poor physique, thin pallid, none 'cirrhotic facies,' icterus, clubbing fingers.There stigmata congenital syphilis.The ribs, hard irregular, apparently projecting from epigastrium easily make out three rounded masses each size walnut.There felt.The Wassermann test negative organs normal.