VA AM ICU report: Pseudocirrhosis

Today we heard a sad case of a middle aged man who presented with new acute liver failure and imaging consistent with pseudocirrhosis, or nodular changes to the liver and usually portal hypertension attributable to metastatic disease in the liver. It’s fairly rare but certainly in our training we will see it. I took most of this from a case review recently published in a gastroenterology journal (, .

  1. Usually seen in breast cancer, but can also be seen in colorectal, pancreatic, lung, and other cancers that metastasize to the liver.
  2. Occurs due to capsular shrinkage from traction from masses and fibrosis around the edge of the metastatic burden.
  3. Usually presents as complications of portal hypertension (ascites, HE, variceal bleeds) but can be found on routine follow-up imaging.
  4. Treatment rests on treating the underlying cancer, though it can, as in this case, be rapidly fatal. 5/6 cases reviewed here died within weeks of a diagnosis of pseudocirrhosis.




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