Cardiopulmonary Arrest on Arrival in an Infant due to Ruptured Hepatoblastoma
Article Outline
Primary tumors of the liver account for approximately 1% of malignancies in children, with an annual incidence of 1.6 cases per million children in the United States.1, 2, 3 Between 50% and 60% of hepatic tumors in children are malignant, and >65% of these are hepatoblastomas.1, 2, 3 Hepatoblastoma occurs predominantly in children <3 years of age.1, 2, 3
A 7-month-old male infant was transferred to our hospital with cardiopulmonary arrest on arrival caused by a ruptured hepatoblastoma. He was born at 41 weeks’ gestation at 3155 g. At 4 months of age, he had developed healthy, and no abnormality was found at a routine health examination. He had fever and diarrhea approximately 5 hours before admission to our hospital; abdominal distension was not noted at this time. Thoracoabdominal radiographs showed abdominal distension (Figure, A). Post-mortem laboratory findings showed anemia (hemogulobin level, 8.1 g/dL) and a high level of alpha-fetoprotein (994 200 ng/mL). Although an autopsy was initially refused by the parents, we obtained permission for post-mortem imaging with computed tomography (CT). Whole body CT revealed multiple tumors in the lung and huge tumors with calcification in the liver (Figure, B and D). After obtaining permission for an autopsy, we confirmed multiple metstatic hepatoblastomas in the lung and a 250-mL abdominal hemorrhage from ruptured hepatoblastomas in the liver (Figure, C and E). With these findings, the cause of death was determined to be ruptured hepatoblastoma with massive abdominal hemorrhage.
Figure.
A, Thoracoabdominal radiograph shows abdominal distension. B and D, Post-mortem CT shows multiple tumors in the lung and huge tumors in the liver. C and E, Autopsy findings show hepatoblastomas in the lung and liver.
Post-mortem imaging is a useful tool in obtaining permission for autopsy when an autopsy is initially refused.4 Our experience suggests that ruptured hepatoblastoma should be considered when an infant has cardiopulmonary arrest and abdominal distension.
References
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- . Liver neoplasia in children. Clin Liver Dis. 2011;15:443–462
- Post-mortem MRI reveals CPT2 deficiency after sudden infant death. Eur J Pediatr. 2010;169:1561–1563
PII: S0022-3476(11)00898-5
doi:10.1016/j.jpeds.2011.08.068
© 2012 Mosby, Inc. All rights reserved.
