Baylor University Medical Center Proceedings April 2014, Volume 27, Number 2 | Page 67
Imaging manifestations of a dreaded obstetric complication
in the immediate postpartum period
Harold Levine, MD, Mehrzad Zarghouni, MD, and Walter Cannon, MD
HELLP (hemolysis, elevated liver enzymes, low platelet) syndrome is a
dreaded complication that may develop during pregnancy or in the immediate postpartum period. Rarely this syndrome manifests itself with
imaging findings. We report a case of HELLP syndrome in which the
diagnosis was reaffirmed via imaging findings.
ELLP syndrome is a descriptive acronym for a pregnancyinduced condition in which the patient presents with
hemolysis, elevated liver enzymes, and low platelets.
About 31% of the time, this syndrome manifests in the
immediate postpartum period (1). While HELLP syndrome
often occurs in the setting of preeclampsia or is thought of as a
variant of the preeclampsia/eclampsia spectrum (4%–12%), it
can occur independently, which can lead to a delay in diagnosis. While the clinical syndromes can overlap, risk factors for
HELLP syndrome and eclampsia differ in that multiparous
mothers and women older than 25 years old have an increased
risk for HELLP syndrome, while classically preeclampsia/eclampsia is associated with maternal age less than 20 or greater
than 45 and in the nulliparous.
Imaging abnormalities are rarely present in HELLP syndrome. However, when present, imaging and clinical presentations are characteristic and complementary in establishing the
correct diagnosis. Clinicians and radiologists should be aware
of the imaging manifestations, as prompt diagnosis and early
treatment are imperative. We describe a case in which the imaging and clinical presentations were characteristic.
H
CASE REPORT
A 22-year-old woman presented with abdominal pain postpartum. Her pregnancy course was complicated by severe preeclampsia, idiopathic thrombocytopenic purpura, and systemic
lupus erythematosus. Immediately in the postpartum period,
she developed progressive epigastric abdominal pain that radiated to her back. Her hematocrit level decreased from 36.8%
to 29.6%, while her aspartate aminotransferase level rose from
40 to 549 U/L and her alanine aminotransferase level rose from
30 to 321 U/L. During this time, her pain became severe, predominantly within the right upper quadrant. An initial hepatic
sonogram was u