Patient Details

Imaging Reports — Plain Explanation

1. USG Both Breasts (31 March 2026) — Breast Ultrasound

• Lactational changes — her breasts show normal changes from breastfeeding (prominent milk ducts)
• No masses or cancer signs — reassuring, no lumps
• Minimal swelling (edema) and water-logging in the area around the nipple of the right breast — minor inflammation, likely related to her overall fluid overload
• Small lymph nodes in both armpits — likely reactive (responding to infection/inflammation), not suspicious for cancer

2. HRCT Thorax (21 March 2026) — High-Resolution CT Scan of the Chest

• Mild cardiomegaly — her heart is slightly enlarged
• Bilateral mild pleural effusions — small amounts of fluid have collected around both lungs
• Basal atelectasis — small collapsed areas at the bottom of the lungs (common with fluid around the lungs)
• Interstitial fluid tracking — fluid seeping into the lung tissue
• Hepatic infarct (right lobe, segments V, VII, VIII) — a portion of her liver has died due to lack of blood supply
• Ascites — fluid collecting inside the abdomen

3. CECT Abdomen (4 March 2026) — Contrast CT of the Abdomen

• Hepatomegaly — enlarged liver
• An 8×3×10 cm wedge-shaped dead area (hypodense = no blood supply) in the right lobe → hepatic infarct (a section of liver tissue has died)

• Bilateral renal cortical necrosis — the outer layer (cortex) of both kidneys shows signs of death/damage from poor blood supply
• Kidney arteries themselves are normal; no stones or hydronephrosis (no blockage)
• This is a very serious finding — it is a known complication of HELLP syndrome and can cause permanent kidney damage or acute kidney failure

• Distended (swollen) with a thickened, edematous wall and sludge (8 mm) — likely inflamed due to the overall illness

• Mild ascites (fluid in abdomen)
• Subcutaneous and intermuscular edema in the abdominal wall — fluid leaking into body tissues

• Uterus is bulky (expected postpartum), IUCD seen in place
• Pancreas, spleen, adrenal glands, bowel, adnexa — all normal
• No abnormal lymph nodes

What is HELLP Syndrome?

• H — Hemolysis (destruction of red blood cells)
• EL — Elevated Liver enzymes (liver damage)
• LP — Low Platelets (bleeding risk)

• Damage to the liver (including infarction, as seen here)
• Kidney failure
• Bleeding tendency
• Fluid overload throughout the body

Treatment Details

• 4 units of PCV (Packed Cell Volume = red blood cells) given across 4 dates in March 2026 — for severe anemia from hemolysis
• 4 units of PRC (Packed Red Cells) given on 3 March 2026

• 21 cycles of HD (dialysis) performed from 1 March through 14 April 2026 — because her kidneys were failing (renal cortical necrosis)
• Injection EPO (Erythropoietin) given on 10 March 2026 — a hormone injection to stimulate the bone marrow to produce more red blood cells

• She was started on higher antibiotics during admission
• She developed DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) — likely due to Levofloxacin (an antibiotic)
• Levofloxacin was stopped
• She was treated with injectable steroids
• Dermatology consultation was obtained and a Drug Card was issued (warning card about the offending drug)

• Fluid from her abdomen was drained and tested
• Result: High SAAG, Low Protein ascites
• High SAAG (Serum-Ascites Albumin Gradient >1.1) means the ascites is caused by portal hypertension (high pressure in the liver's blood supply) — consistent with severe liver damage from HELLP

Summary of the Clinical Picture

1. Liver infarction (a large segment of liver died from loss of blood supply)
2. Bilateral renal cortical necrosis → requiring prolonged dialysis (21 sessions over 6 weeks)
3. Severe anemia → requiring multiple blood transfusions and EPO
4. Pleural effusions and ascites (fluid around lungs and in abdomen) from portal hypertension/hypoalbuminemia
5. DRESS drug reaction to Levofloxacin — an additional serious complication during her hospital stay