Solitary necrotic nodules in the liver present a diagnostic challenge due to their rarity and resemblance to metastatic tumors. We report a case where imaging revealed multiple hepatic lesions suggestive of malignancy, prompting a needle biopsy. Histopathology confirmed necrosis without malignancy. Despite advancements in imaging modalities, distinguishing solitary necrotic nodules from metastases remains difficult. Recognition of characteristic imaging features and consideration of biopsy are crucial for accurate diagnosis and management. This case underscores the importance of thorough evaluation and differential diagnosis in liver lesions to prevent unnecessary surgical interventions and ensure appropriate clinical care.
BACKGROUND: Persistent inflammatory response after transcatheter aortic valve implantation (TAVI) is one of the possible causes of early and mid-term postprocedural adverse events. OBJECTIVES: To establish the predictive role of whole blood parameters on inflammatory response characteristics within a 1-year follow-up. MATERIAL AND METHODS: The study group comprised 163 consecutive patients (52.1% females), mean age 78.6 (±6.6) years (± standard deviation (SD)) who underwent TAVI and completed 1-year follow-up on-site examinations. Patients were retrospectively divided into acute kidney injury (AKI) and non-AKI subgroups. Clinical and laboratory data were collected. In-hospital and follow-up outcomes were assessed. RESULTS: The clinical and procedural details did not show significant differences between AKI and non-AKI groups. Neutrophil-to-lymphocyte ratio (NLR) decreased from baseline to measurement after 1 year with a statistically significant decline in the whole study population and non-AKI subgroup (both p = 0.005). The baseline NLR cutoff value of 4.2 for the non-AKI group ((area under the curve (AUC) = 0.718, p < 0.0001; sensitivity 46.27%, specificity 92.31%) and of 3.8 for the AKI group (AUC = 0.673, p = 0.0174; sensitivity 59.25%, specificity 84%) had prognostic properties for persistent NLR elevation. CONCLUSIONS: The NLR decreases after TAVI, and this phenomenon is more evident in patients without AKI. Furthermore, baseline NLR cutoff values may be considered predictors of persistence of inflammatory response.
Acute Kidney Injury , Aortic Valve Stenosis , Transcatheter Aortic Valve Replacement , Acute Kidney Injury/diagnosis , Acute Kidney Injury/etiology , Aged , Aortic Valve Stenosis/surgery , Female , Follow-Up Studies , Humans , Lymphocytes , Male , Neutrophils , Retrospective Studies , Risk Factors , Transcatheter Aortic Valve Replacement/adverse effects , Treatment Outcome
BACKGROUND: Excessive metabolic excitation of platelets after cardiac procedures may be related to some adverse events but assessment of their metabolic activity is not routine. The purpose of this study was to evaluate which of the basic platelet morphological parameters best reflects their metabolic status. METHODS: The blood samples of 22cardiac surgical patients (mean age of 62.3 ± 10.3 years) were taken before surgery (BS), and 1, 24 and 48 hours after the operation. Correlations between morphological platelet parameters (platelet count [PLT], mean platelet volume [MPV], platelet distribution width [PDW] and MPV/PLT) and their metabolic activity (total concentration of malondialdehyde [MDA] and MDA/PLT) were estimated. RESULTS: Significant decline in PLT after operation (from 223 ± 44 × 10¹²/L to 166 ± 57 × 10¹²/L) was accompanied by marked increase in MPV (from 8.4 ± 0.9 fL to 9.1 ± 1.2 fL) and no change of PDW. Consequently, MPV/PLT index increased significantly after procedures from (median with IQR) 0.038 (0.030-0.043) to 0.053 (0.043-0.078). Simultaneously, a significant increase in total platelet MDA content and MDA/PLT was noted reaching peak levels soon after operation. The strongest correlation was observed between MPV/PLT and MDA/PLT (r = 0.56; p < 0.001), although the others were also found to be significant (MDA/PLT vs. MPV; r = 0.35; MDA/PLT vs. PDW; r = 0.34). CONCLUSIONS: Among basic morphological parameters and indices, the MPV-to-PLT ratio reflects the best metabolic status of platelets in cardiac surgical patients.
BACKGROUND: Although considered a minimally invasive procedure, transcatheter aortic valve implantation (TAVI) generates an inflammatory response which is related to post-procedural complications including acute kidney injury (AKI). The aim of the present study was to analyse the association between simple, easily available post-operative morphological parameters of inflammatory status such as neutrophil-to-lymphocyte ratio (NLR) and AKI as well as post-discharge survival. METHODS: The study group was comprised of 203 consecutive patients (102 females and 101 males, mean age 78 ± 6.9 years) who underwent TAVI between January 2013 and March 2017. Demographic and clinical data were collected. Baseline and subsequent post-procedural blood samples (8, 24, 48, 72 at discharge) were taken. Blood morphology (including NLR) and creatinine concentration were assessed. Long-term survival was also analyzed. RESULTS: Seventy-four (36.5%) patients developed AKI. Baseline morphological parameters did not differ between subject with and without AKI. Those reflecting post-procedural inflammatory response, including leucocytes, neutrophils and NLR increased significantly following TAVI in both subgroups and the rise was more pronounced in AKI patients (p < 0.001). A comparison of Kaplan-Meier curves for patients with the lowest (NLR 1; below 25th percentile) and highest NLR (NLR 3; above 75th) revealed a significant difference in the log-rank test (p = 0.049). Estimated probability of 1-, 2- and 5-year survival were 100% vs. 79%, 94% vs. 77% and 75% vs. 46%, respectively in subgroup NLR 1 and NLR 3. CONCLUSIONS: Inflammatory response after TAVI, estimated by means of NLR, is more pronounced in patients with AKI. A higher value of NLR is associated with a lower probability of long-term survival after TAVI.
INTRODUCTION: Transcatheter aortic valve implantation (TAVI) although minimally invasive is still accompanied by changes in blood morphological parameters, some of them linked to unfavorable outcomes. AIM: To find any association between changes in blood morphology reflecting an inflammatory response and acute kidney injury (AKI). MATERIAL AND METHODS: This study involved 176 consecutive transfemoral TAVI patients with a mean age of 78.4 ±7.0 years. Serum creatinine concentration (CREA) and blood morphology were analyzed in the blood samples taken before the procedure, then approximately 1, 24, 48 and 72 hours after the procedure, and lastly at the time of discharge. Post-procedural maximal or minimal values (max/min) and max/min-to-bs ratio of the laboratory parameters were also calculated. RESULTS: Leucocyte (WBC) and neutrophil (NEUT) counts increased significantly after the procedure whereas lymphocyte (LYMPH) counts declined markedly, reaching the highest or lowest values 24 hours after the procedure. A significant increase in neutrophil-to-lymphocyte ratio (NLR) was observed. Platelet count (PLT) dropped to a minimum at 72 hours after TAVI but at discharge did not return to the admission level. TAVI was associated with a marked increase in CREA with a peak at 48 hours after the procedure (135.7 ±75.9 µM/l). Patients with AKI (n = 65; 36.9%) presented more pronounced variations in relative changes in counts of all blood morphological parameters. A positive moderate (r = 0.412) correlation between maximal NLR and relative CREA changes was noted. CONCLUSIONS: TAVI is associated with significant changes in blood morphological parameters that reflect an inflammatory response. They are more pronounced among subjects with post-procedural AKI.
