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EHS

Black Smoke Arising in the Duodenum After Liver Biopsy: What Does the Smoke Signal Mean?

Question: A 65-year-old Caucasian woman with a history of severe aplastic anemia status post hematopoietic stem cell transplant was referred for the evaluation of unexplained thrombocytopenia and esophageal varices identified during a surveillance computed tomography scan. Serologic workup was unrevealing for viral hepatitides and other etiologies of chronic liver disease. Given the lack of a clinical diagnosis, with evidence of portal hypertension, the patient underwent a transjugular liver biopsy (TJLB) and hepatic venous pressure gradient measurements followed by esophagogastroduodenoscopy (EGD) to confirm the presence of varices during the same procedural session.

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