OBJECTIVES: Our objective was to describe the hepatic imaging findings in 
selected patients with HELLP syndrome (hemolysis, elevated liver enzymes, and 
low platelet count) and to correlate these findings with the severity of 
concurrent clinical and laboratory abnormalities.
STUDY DESIGN: Patients with laboratory criteria for HELLP syndrome with 
complaints of severe right upper quadrant abdominal pain in association with 
either shoulder pain, neck pain, or relapsing hypotension underwent imaging of 
the liver. Clinical and laboratory parameters were then correlated with the 
hepatic imaging findings.
RESULTS: Thirty-four patients were evaluated in this study. Computed tomographic 
scanning of the liver was used for 33 patients. Additional imaging evaluations 
included magnetic resonance imaging for 4 patients and ultrasonographic 
evaluation of the liver for 5 patients. In 15 cases (45%) the computed 
tomographic results were abnormal. The most frequent abnormal hepatic imaging 
findings were subcapsular hematoma (n = 13) and intraparenchymal hemorrhage (n = 
6). There was no statistically significant correlation between the presence of 
an abnormal hepatic imaging finding and the severity of liver function test 
abnormalities. However, the severity of thrombocytopenia did correlate with 
hepatic imaging findings (p = 0.04). In particular, an abnormal hepatic imaging 
finding was noted for 10 of 13 patients (77%) with a platelet count of < or = 20 
x 10(9)/L (p = 0.012).
CONCLUSIONS: Abnormalities in liver function test results do not accurately 
reflect the presence of abnormal hepatic imaging findings in HELLP syndrome. 
Patients with HELLP syndrome having complaints of right upper quadrant pain and 
neck pain, shoulder pain, or relapsing hypotension should undergo imaging of the 
liver.