The liver in fatal exertional heatstroke

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Abstract
The chronology of hepatic histopathologic alterations in 50 cases of fatal exertional heat stroke related to military training are described. Five patients who died in the field demonstrated the earliest alterations: fatty change (sometimes microvacuolar), amitotic hepatocellular regeneration, accumulation of hemosiderin and congestion. In addition, the sinusoids contained polymorphonuclear leukocytes, immature erythroid and granulocytic cells, megakaryocytes and lymphocytes. Fibrin was not evident. The other 45 patients, who survived up to 8 days following hospitalization, also demonstrated these findings. Microvacuolar fatty change was common in this group of patients, and degenerated hepatocytes resembled Councilman bodies. Coagulative degeneration and submassive necrosis were uncommon. Of those surviving over 12 h, more than half had bile stasis (sometimes ductal), frequently associated with acute cholangitis and ductular proliferation. Regeneration and pigmentary alterations have not been recognized as early hepatic findigns in heat stroke, nor have intrasinusoidal bone marrow elements, ductal bile stasis and acute cholangitis been described. Possible pathogenetic factors, other than hyperthermia and sequellae of shock, include obesity, recent illnesses and immunizations, bacterial toxemia, hemolysis and bone marrow injury.

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