D'Cruz C A, Wimmer R S, Harcke H T, Huff D S, Naiman J L
Cancer. 1983 Nov 15;52(10):1803-7. doi: 10.1002/1097-0142(19831115)52:10<1803::aid-cncr2820521007>3.0.co;2-d.
Three children developed acute veno-occlusive disease of the liver following combination chemotherapy for acute myelocytic leukemia. The clinical presentation was similar in all three, with acute onset of hepatomegaly and thrombocytopenia in the absence of significant transaminasemia or icterus. In all three patients, radionuclide imaging with technetium-99m sulfur colloid showed hepatosplenomegaly, decreased liver uptake, and increased splenic activity. The results of liver biopsy established the diagnosis, revealing marked centrilobular congestion with hemorrhage into the spaces of Disse, atrophy of central hepatic cords, and edema of the walls of the central and sublobular veins. Each patient showed marked improvement following temporary cessation of chemotherapy. The diagnosis of veno-occlusive disease is suggested by the triad of: (1) clinical signs and symptoms; (2) scintigraphic findings; and (3) temporal relationship to chemotherapy.
三名儿童在接受急性髓细胞白血病联合化疗后发生了急性肝静脉闭塞病。三名患儿的临床表现相似，均为急性肝肿大和血小板减少起病，且无明显转氨酶升高或黄疸。所有三名患者经锝-99m硫胶体放射性核素显像均显示肝脾肿大、肝脏摄取减少和脾脏活性增加。肝活检结果确诊，显示明显的小叶中心充血，狄氏间隙出血，中央肝索萎缩，中央静脉和小叶下静脉壁水肿。每名患者在暂时停止化疗后均有明显改善。肝静脉闭塞病的诊断可根据以下三联征提示：（1）临床体征和症状；（2）闪烁显像结果；（3）与化疗的时间关系。
