PMC10276616_01
CT and pathological features in case 1. (a) CT scan shows diffuse hepatomegaly, heterogeneous density of the liver parenchyma, unclear delineation of the hepatic vein, and ascites (*). (b) Histopathology results reveal congestion, hemorrhage (white arrow), and coagulation-like necrosis (black arrow) in the central area of the liver (HE staining, 10 x 10).
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Hemorrhagic necrosis was observed on HE staining (Figure 2).
PMC10276616_02
CT and pathological features in case 2. (a) CT scan shows heterogeneous density of the liver parenchyma, unclear clover-like enhancement of the hepatic vein, and ascites (*). (b) In the third month of the disease course, the CT scan shows homogenous density of the liver parenchyma and clearly exposed hepatic veins (black arrow). (c) Histopathology results show hepatic sinus congestion (black arrow) and inflammatory cell infiltration in a bridge-like pattern (black arrow) (HE staining, 10 x 10). (d) Mild fibrosis is seen around the sinus (black arrow) (Masson staining, 20 x 10).
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Fibrotic embolism was observed in the central vein, and perisinusoidal fibrosis was also noted (Figure 3c and d).
PMC10276616_03
CT and pathological features in case 3. (a) CT scan shows diffuse hepatomegaly, heterogeneous density of the liver parenchyma, unclear delineation of the hepatic vein, and ascites (*). (b) In the eighth month of the disease course, the CT scan shows clearly exposed hepatic veins (black arrows) and homogenous density of most liver regions with the persistence of heterogeneity in a few remaining areas. (c) Histopathology results show central vein fibrosis (black arrow), absence of peripheral hepatocytes, infiltration of inflammatory cells, and hepatic sinusoidal dilatation (white arrows) (HE staining, 20 x 10). (d) Central venous occlusion (black arrow) and hepatic sinusoidal dilatation (white arrows) are observed (Masson staining, 10 x 10).
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After 30 days of treatment, the symptoms of the patient improved, and her biochemical indices and CT findings were close to normal (Figure 4a and b). Anticoagulant therapy with rivaroxaban tablets was then initiated for the patient (Figure 4c and d).