Abstract
We report a case of hepatic infarction caused by the occlusion of both the hepatic artery and the superior mesenteric artery (SMA). In this case, we detected a thrombus at the left atrium as the embolic source by transesophageal echocardiography (TEE). A 53-year-old man was admitted to a local hospital with a diagnosis of renal infarction and atrial fibrillation. Seven days later he was transferred to our hospital because of complications from cerebral infarction. On the 2nd hospital day, a floating thrombus at the left atrial appendage was detected by TEE. On the 11th hospital day, he failed into shock and abdominal distension developed. Serum transaminase levels were markedly elevated. Computed tomography with a contrast agent showed a segmental non-enhancing lesion of the liver. At that time, TEE showed the disappearance of the left atrial thrombus. His condition worsened rapidly, and he died of multiple organ failure. Autopsy findings showed the thromboembolism of both the hepatic artery and the SMA, extensive liver infarction and massive intestinal necrosis. In this case, it is suggested that the obstruction of the hepatic artery and the SMA brought about a decrease in blood flow through the hepatic artery and the portal vein, and caused liver infarction.
