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Luque-Cabal M, Álvarez-Guisasola V, Rizzo-Raza S, Sales-Fernández C, Escudero-Caro T. Case 304: Porphyria Cutanea Tarda. Radiology 2022; 304:488-492. [PMID: 35877548 DOI: 10.1148/radiol.204599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
HISTORY In 2017, a 72-year-old woman was seen in the gastroenterology department with a 2-month history of mild and intermittent abdominal pain without other accompanying symptoms. Her medical history was unremarkable, except for a previous visit due to facial photodermatitis 3 years earlier. Diazepam for a sleeping disorder was the only chronic medication recorded. Results of physical examination, blood count, and basic metabolic panels including assessment of renal and liver function were normal; only the ferritin level was slightly elevated (265 ng/mL [595 pmol/L]; normal range, 10-120 ng/mL [22-269 pmol/L]). Abdominal US was performed, followed by multiphasic contrast-enhanced CT and liver MRI due to the findings of the first study. A diagnosis was not established in that moment, and acetaminophen was prescribed for pain relief. As the symptoms continued, laboratory tests and imaging studies were repeated 2 years later, with similar findings and no notable changes.
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Affiliation(s)
- María Luque-Cabal
- From the Department of Radiology, Hospital Universitario Río Hortega, C/ Dulzaina s/n, Valladolid 47010, Spain
| | - Verónica Álvarez-Guisasola
- From the Department of Radiology, Hospital Universitario Río Hortega, C/ Dulzaina s/n, Valladolid 47010, Spain
| | - Sofía Rizzo-Raza
- From the Department of Radiology, Hospital Universitario Río Hortega, C/ Dulzaina s/n, Valladolid 47010, Spain
| | - Covadonga Sales-Fernández
- From the Department of Radiology, Hospital Universitario Río Hortega, C/ Dulzaina s/n, Valladolid 47010, Spain
| | - Trinidad Escudero-Caro
- From the Department of Radiology, Hospital Universitario Río Hortega, C/ Dulzaina s/n, Valladolid 47010, Spain
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Naganuma H, Ishida H, Yoshida M, Funaoka M, Ito S, Ohyama Y. Multinodular fatty change in the liver in three patients with chronic hepatic porphyria: Contribution of sonography to the diagnosis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:165-168. [PMID: 30378127 DOI: 10.1002/jcu.22660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 09/26/2018] [Accepted: 10/05/2018] [Indexed: 06/08/2023]
Abstract
We present three cases of chronic hepatic porphyria (CHP) in alcoholic patients, in which grayscale ultrasound (US) revealed multiple echogenic masses in the liver, mimicking multinodular hepatocellular carcinoma on alcoholic liver injury. In all cases, contrast-enhanced US (CEUS) showed iso-enhancement of the mass lesions throughout all vascular phases. Additionally, two-dimensional shear wave elastography (2DSWE) (performed in two cases) revealed the mass to have almost the same SWE value as the surrounding parenchyma. When encountering alcoholic patients with multiple echogenic masses in the liver, CHP must be included in the differential diagnosis. CEUS and 2DSWE allow us to increase our diagnostic confidence of CHP.
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Affiliation(s)
- Hiroko Naganuma
- Department of Gastroenterology, Yokote Municipal Hospital, Yokote, Japan
| | - Hideaki Ishida
- Department of Gastroenterology, Akita Red Cross Hospital, Akita, Japan
| | - Makoto Yoshida
- Department of Cellular and Organ Pathology, Graduate School of Medicine, Akita University, Akita, Japan
| | - Masato Funaoka
- Department of Gastroenterology, Yokote Municipal Hospital, Yokote, Japan
| | - Shuichi Ito
- Department of Gastroenterology, Yokote Municipal Hospital, Yokote, Japan
| | - Yoko Ohyama
- Department of Clinical Laboratory, Akita Kousei Medical Hospital, Akita, Japan
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Delli Pizzi A, Mastrodicasa D, Sessa B, Cianci R, Caulo M, Basilico R. Multiple liver pseudotumors due to hepatic steatosis and fatty sparing: A non-invasive imaging approach. Eur J Radiol Open 2019; 6:56-59. [PMID: 30671499 PMCID: PMC6335587 DOI: 10.1016/j.ejro.2019.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/05/2019] [Accepted: 01/08/2019] [Indexed: 12/15/2022] Open
Abstract
Hepatic steatosis is a frequent benign liver condition that can be idiopathic or secondary. The degree of fatty liver infiltration can be focal, diffuse or patchy. In this study, we present two patients with hepatic steatosis and multiple nodular liver lesions, due to fatty infiltration and fatty sparing respectively, mimicking a primary tumor or metastases (“pseudotumors”). Since the differential diagnosis of this kind of lesions can be difficult based on imaging alone, the knowledge of Contrast-Enhanced Ultrasound (CEUS) and Magnetic Resonance Imaging (MRI) findings may help radiologists to avoid an incorrect diagnosis of liver tumor, and unnecessary biopsies.
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Affiliation(s)
- Andrea Delli Pizzi
- ITAB Institute for Advanced Biomedical Technologies, University "G. d'Annunzio", Chieti, Italy
| | | | - Barbara Sessa
- ITAB Institute for Advanced Biomedical Technologies, University "G. d'Annunzio", Chieti, Italy
| | - Roberta Cianci
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Massimo Caulo
- ITAB Institute for Advanced Biomedical Technologies, University "G. d'Annunzio", Chieti, Italy.,Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
| | - Raffaella Basilico
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti, Italy
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Analysis of refractive artifacts by reconstructed three-dimensional ultrasound imaging. J Med Ultrason (2001) 2016; 33:11-6. [PMID: 27277613 DOI: 10.1007/s10396-005-0072-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2005] [Accepted: 08/29/2005] [Indexed: 12/20/2022]
Abstract
PURPOSE Refractive artifacts are frequently encountered in clinical settings, and they have been analyzed on the basis of conventional two-dimensional (2-D) ultrasound (US) images, but this method is restricted to monoplane data and is limited by its inability to assess the three-dimensional (3-D) structure of refractive artifacts. The aim of this study was to evaluate the role of reconstructed 3-D US images in the analysis of refractive artifacts. METHODS The following representative refractive artifacts were analyzed on the basis of reconstructed 3-D US images: (a) a distorted image of a fine tube behind a cyst (balloon); (b) a deformed image of the bottom of a balloon; and (c) a duplication artifact due to the acoustic lens effect. RESULTS (a) A tube was imaged as a fine echogenic line with two points of sudden interruption, unlike a curved needle, which was imaged without interruption. (b) 3-D US allowed us to visualize the mode of deformity in the image of the bottom of a fluid-filled balloon in a water bath. When the acoustic velocity in the fluid was greater than that in the surrounding water, the bottom of the balloon appeared to be shrunken. When the acoustic velocity in the fluid was less than that in the surrounding water, the bottom of the balloon appeared to be swollen. (c) When we placed two pieces of white chicken meat in front of a fine needle, the needle was duplicated in the resulting image. In this case, the needle appeared to be vague and fuzzy. In this case, 3-D US did not add further information to the 2-D images. CONCLUSIONS Our study suggests that reconstructed 3-D US images provide a better understanding of the mode of refractive artifacts than do 2-D US images.
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Tebala GD, Jwad A, Khan AQ, Long E, Sissons G. Multifocal Nodular Fatty Infiltration of the Liver: A Case Report of a Challenging Diagnostic Problem. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:196-202. [PMID: 27017525 PMCID: PMC4811288 DOI: 10.12659/ajcr.897283] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Patient: Female, 59 Final Diagnosis: Multifocal nodular fatty infiltration of the liver Symptoms: None Medication: — Clinical Procedure: Laparoscopy Specialty: Surgery
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Affiliation(s)
- Giovanni Domenico Tebala
- Department of Surgery, Colorectal Cancer Multidisciplinary Team, Noble's Hospital, Douglas, Isle of Man, United Kingdom
| | - Anees Jwad
- Department of Radiology, Colorectal Cancer Multidisciplinary Team, Noble's Hospital, Douglas, Isle of Man, United Kingdom
| | - Abdul Quyyum Khan
- Department of Surgery, Colorectal Cancer Multidisciplinary Team, Noble's Hospital, Douglas, Isle of Man, United Kingdom
| | - Ervine Long
- Department of Pathology, Colorectal Cancer Multidisciplinary Team, Noble's Hospital, Douglas, Isle of Man, United Kingdom
| | - Guy Sissons
- Department of Radiology, Colorectal Cancer Multidisciplinary Team, Noble's Hospital, Douglas, Isle of Man, United Kingdom
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Shinya T, Sato S, Akaki S, Ogata T, Kato K, Tone A, Kanazawa S. Computed tomography findings of congenital generalized lipodystrophy: multiple nodular fatty liver and diffuse sclerosis of bones. ACTA ACUST UNITED AC 2007; 25:484-7. [PMID: 18026908 DOI: 10.1007/s11604-007-0166-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Accepted: 06/20/2007] [Indexed: 11/28/2022]
Abstract
Congenital generalized lipodystrophy (CGL) is a rare autosomal recessive disease that is also referred to as Berardinelli-Seip syndrome. It is characterized by a lack of adipose tissue throughout the body from birth, muscular hypertrophy, advanced bone age, fatty liver, and insulin resistance. We describe computed tomography (CT) and magnetic resonance findings for a 35-year-old woman with CGL. Multiple nodular, well-defined regions of fatty infiltration of the liver are rare and have never been previously reported in a patient with lipodystrophy. To our knowledge, this is the first report describing CT findings of bone sclerotic changes associated with CGL.
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Affiliation(s)
- Takayoshi Shinya
- PET-RI Center, Okayama Kyokuto Hospital, 567-1 Kurata, Okayama 703-8265, Japan.
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Berkovic D, Nolte W. Gyriform Liver Foci in Chronic Hepatic Porphyria. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2003. [DOI: 10.1177/8756479303256087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A patient with suspected liver metastases detected by routine sonography of the abdomen was admitted to our clinic for further testing. Liver sonography disclosed multiple irregular gyriform foci of a hyperechoic structure with a maximum diameter of 3.5 cm. In magnetic resonance imaging, these foci appeared as hyperintense in T1-weighted images and isointense in T2-weighted images. A biopsy showed a discrete portal and periportal fibrosis. UV light fluorescence of the specimen was negative. Analysis of urine revealed an almost fourfold el-evation of total porphyrin of 591 µg/24 h, proving the diagnosis of chronic hepatic porphyria. Characteristic liver foci in hepatic porphyria are detected by sonography in some affected patients. Usually, they can also be depicted by magnetic resonance imaging and computed tomography. These foci often appear before any other symptoms of the disease and are reversible when triggering factors, such as certain drugs or alcohol, are discontinued.
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Affiliation(s)
- Dinko Berkovic
- From the Center of Internal Medicine, Clinic of the Georg-August-University, Göttingen, Germany,
| | - Wilhelm Nolte
- From the Center of Internal Medicine, Clinic of the Georg-August-University, Göttingen, Germany
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