Pattern of Necrosis in Acute Viral Hepatitis

Of 170 patients with biopsy-documented acute viral hepatitis, 52 exhibited zones of hepatic necrosis and collapse that bridged adjacent portal triads or central veins (or both), a lesion classified as subacute hepatic necrosis (SHN). Whereas the clinical course in the 118 patients with the classic type of spotty necrosis (CH) was relatively benign, 19 per cent of those with SHN lesions died, and cirrhosis developed in 37 per cent. Ascites, edema and hepatic coma, which occurred in approximately a quarter of the SHN patients, were the only clinical manifestations that clearly distinguished between the two groups. The pattern of hepatic necrosis characterized by intralobular and interlobular bridging of portal triads or central veins, when found during the acute phase of viral hepatitis, indicates a severe form of the disease that may lead to fatal hepatic failure or the development of cirrhosis in a significant number of patients.