A case of liver cirrhosis associated with multiple necrotic nodules in the liver after the hepatic hydrothorax

A 91-year-old Japanese female had been diagnosed to have liver cirrhosis caused by NASH approximately 10 years prior to this presentation, and had been treated with oral medication. She was admitted to our hospital for the purpose of controlling ascites. Liver cirrhosis associated with a large amount of ascites was observed on ultrasonography and computed tomography (CT) on admission, and the treatment with diuretics and paracentesis was initiated. On the 36th day after her admission, dyspnea and hypoxemia suddenly occurred, and an X-ray showed right hydrothorax. The serum levels of AST and ALT were elevated to 439 IU/l and 1196 IU/l, respectively, on the ninth day after the occurrence of hepatic hydrothorax. Ultrasonography and CT revealed multiple hypoechoic and low density nodules in the liver and a portal thrombus. On the 19th day after the occurrence of right hydrothorax, the patient died of liver and respiratory failure. On autopsy, liver cirrhosis, portal thrombus, right hydrothorax, right atelectasis and ascites were observed. The multiple hypoechoic and low density nodules in the liver proved to be completely necrotic tissue of pseudolobules, which were caused by an ischemic liver, which were suspected to have been caused by hypoxia due to the hydrothorax and decreased portal vein flow due to the portal thrombus.