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