A week-old infant was brought in with a history of possible unsafe sleeping conditions. At autopsy, the decedent was noted to have a large ASD. Examination of the liver revealed severe centrilobular congestion with hepatic necrosis.
Here’s a panorama view:
The liver was largely necrotic, with broad areas of coagulative necrosis:
The areas around central venules were almost all necrotic:
Though there were areas of preserved hepatocytes:
I usually see congestive hepatopathy in adults with right-sided heart failure. Usually it’s just centrilobular congestion with a bit of fibrosis. I haven’t seen this kind of coagulative necrosis in a long time. There seems to be a current trend to look to asphyxia and “unsafe sleep” for infant sudden death — not that I think anybody would make that mistake here. My personal opinion is that there’s a bit of diagnostic drift in this trend. I remember in the old days when everything was “shaken baby.” Easy answers are sometimes too easy.
As always, free for use in lectures, etc. with or without attribution, though attribution is appreciated. Higher resolution images are available if you contact me.