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Mann, 78 J., chronische Rechtsherzinsuffizienz infolge schwerer chronischer
Bronchitis mit Stauung im grossen Kreislauf. Autopsiepräparat
- Vor allem zentroazinäre Nekrose
von Hepatozyten und beginnende Fibrose
- Konkav begrenzte zentro-zentrale Nekrosebrücken (Zone 3)
- Hyperämie, Dilatation der blutgefüllten Sinusoide
Andere Ursachen von Lebernekrosen (unsystematisch verteilt): Akute
Virushepatitis, vor allem HBV und HCV mit massiver immunologischer
Zerstörung virusbefallener Hepatozyten, oder Pilzvergiftung (z.B.
Amanita phalloides).
78-year-old male suffered from chronic right heart failure with venous congestion due
to chronic obstructive lung disease (specimen from autopsy).
- Centrilobular parenchymal atrophy
- Extensive centrilobular bridging fibrosis
- Numerous pigment laden macrophages as a consequence of old centrilobular hemorrhagic necrosis (Nekrose) due to an episode of acute liver hypoperfusion
- Prominent bile ductular proliferations
- Presence of macro- and microvesicular steatosis in the viable periportal tissue.
Histologic features of both chronic passive hepatic congestion and centrilobular necrosis frequently occur together. Chronic passive hepatic congestion
and centrilobular necrosis form a morphological continuum reflecting degrees of preexisting hepatic congestion and acute liver hypoperfusion leading to
necrosis. The liver's gross appearance results from the contrast of red-brown centrilobular regions suffused with blood against viable, if somewhat fatty,
periportal tissue.