69 Is Green the New Red (Is Dead): Ischemic Myocardial Necrosis Highlighted in Patients with Liver Failure.

Résumé fourni par la source

Abstract Color and pigment of tissue are essential components of gross evaluation of organs, often providing valuable clues to diagnoses. The staging of ischemic injury to myocardium incorporates such features as early pallor, yellow-tan myocardium or gray change in granulation tissue, and white coloration in completely healed infarction. Some patients with liver failure have been found to have green pigmentation in areas of myocardium secondary to infarction which has not been previously characterized in standard cardiac pathology literature. A natural language search of the anatomic pathology system was performed for patients (GREEN) who, over the last ten years, had green discoloration (GD) or pigment of the epicardium, myocardium, or epicardium noted in the gross description. All 25 of the patients identified also have liver failure (20 chronic, 5 acute fulminant). A group (RED) of age-comparable patients with acute myocardial infarction without chronic liver disease was identified. Myocardial injury, acute and chronic inflammation and healing response in MI were graded semi-quantitively in both GREEN and RED groups. Serum total bilirubin levels along with duration of jaundice, were obtained via the Electronic Health Record (EHR) for both groups. Nineteen patients with liver failure/cirrhosis but without green myocardium served as an age comparable control group. Among the 25 patients (19 M, 6 F) ranging from 4 months to 76 years age (mean 55.4 years), the GREEN group had higher hyperbilirubinemia (mean 20.9 ng/ml) and greater duration of jaundice (mean 39.1 days). In the GREEN group, GD was present in the myocardium in 23/25 (92%), with three layer involvement (epi, myo, endo) in 9/25 (36%) and endocardium only in 2/25 (8%). Acute myocardial injury was present microscopically in 10/23 (43%) GREEN patients with GD. Duration of ischemic injury ranged from 2 days to 3 weeks. Injury, acute and chronic inflammation, myocyte dropout, vascular proliferation, and collagen deposition was similar in both GREEN and RED groups with similar time intervals. In addition, diffuse GD was present in the aortic intima in 2/23 patients with dark GD of an aortic intimal atherosclerotic plaque in 1/23 patient. GD can be seen in all layers of the heart in patients with acute and chronic liver failure, usually associated with marked serum hyperbilirubinemia. Discrete darker green regions in the myocardium often outline regions of acute and healing ischemic injury.

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