Liver circulation measured by 3D and color Doppler US in HELLP syndrome

Aim and background: HELLP, a syndrome characterized by hemolysis, elevated liver enzyme levels and a low platelet count, is a frequently misdiagnosed obstetric complication. Generally it is a part of preeclampsia, but it can exist separately. The most important thing is the early diagnosis because of the high mortality rates. The aim of this study was to detect the ultrasound signs of this syndrome.

Case report: A pregnant woman was admitted to the intensive care unit of our hospital because of jaundice and abdominal pain. The laboratory tests showed elevated liver enzymes and low platelet count. The ultrasound (US) examination found hepatomegaly, inhomogeneous liver pattern, dilated portal veins and ascites. The Doppler examination showed signs of portal hypertension. Clinical, laboratory and ultrasound signs supported the existing HELLP syndrome.

The patient had gastrooesophageal bleeding and required transfusion and supportive therapy. There were no signs of eclampsia and the delivery was successful without complications. At the follow up examinations of our patient the signs of portal hypertension and diffuse liver lesion disappeared.

Conclusion: The abdominal two- and three-dimensional (2D and 3D) and Doppler ultrasound support the early diagnosis of HELLP syndrome based on the clinical and laboratory signs.