Case

Contributed by :

abdomenrad

Patient Data :


Age : 67 - Gender : Female

Diagnosis :

Actinomycotic hepatic abscess

Findings :

A large mass is seen in the right lobe of the liver, which shows significant contrast enhancement on arterial phase, and peripheral rim-like enhancement on delayed phases. The lesion has high signal on T2WI compared to normal liver parenchyma. Perilesional T2 signal increase is compatible with edema. Additionally, perihepatic fluid adjacent to the lesion is seen.

History :

A patient with fever and right upper quadrant pain admited to ER. In her blood tests, AFP was normal and WBC was slightly elevated.
     
     
     
Comments
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Ali ;
10/6/2014 7:22:03 PM
There is a hypervasculary mass in the right lobe. HCC or hypervasculary metastasis should be considered.
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Kerem ;
10/6/2014 7:45:13 PM
My favorite diagnosis is HCC or adenoma rupture because of adjacent perihepatic fluid.
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Anonymous ;
10/6/2014 8:58:44 PM
The lesion has enhancement, signal and washout characteristics of an HCC which has ruptured throught the capsule with peritoneal capsular tumor seeding and trace fluid in a liver with possible cirrhosis (widened fissure for the falciform ligament). Do no see a cause for infection and AFP does not need to be elevated in patient with HCC (although it's helpful).
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Ruslan ;
10/8/2014 11:02:28 AM
İt looks like HCC ...
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Erce ;
10/9/2014 8:36:02 AM
I consider HCC first. Hypervascular metastasis must be included as differential.
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Ruslan Sh. ;
10/9/2014 8:50:12 AM
There is a hint on an infection in the history of the patient...Maybe it is an abscess???
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ibrahim ;
10/9/2014 4:57:58 PM
@Ruslan, I have never seen such a hypervascular abcess before. Contrast enhancement patern of the lesion is more suggestive of hypervascular liver lesions such as HCC, adenoma, FNH, and metastasis.
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murat danacı ;
10/9/2014 10:16:49 PM
There is a large mass in the right liver lobe. Lesion is hypervascular on dynamic series. There are alot of large lymph nodes in hiler region. Capsular retraction and extracapsular extension or seeding are seen adjaccent to the lesion. All findings suggest a malignant lesion. My first diagnosis is peripheral cholangiocarcinoma+ hilary metastatic lymph nodes+extracapsular extension+ascites. Differential diagnosis includes neuroendocrin tumor, HCC. HCC's larger than 5 cm enhance heterogenously ( mosaic pattern). Extracapsular extansion and capsular retraction are rare. Cholangiocarcinomas are hypovascular in general but they can be hypervascular.
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Mustafa Harman ;
10/10/2014 4:20:15 PM
My favorite diagnosis is cholangiocarcinoma (Capsular retraction, extrahepatic invasion, periportal lymph nodes are important findings)
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Ercan ;
10/11/2014 5:21:21 PM
Without contrast images, it seems like cholangiocarcinoma, but postcontrast images are confusing. Arterial phase image doesn't fit other sequences.
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