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Focal Benign Liver Lesions and Their Diagnostic Pitfalls. Radiol Clin North Am 2022; 60:755-773. [DOI: 10.1016/j.rcl.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Horst LJ, Weidemann S, Lohse AW, Sebode M. [Hepatic granuloma-A diagnostic challenge]. Z Rheumatol 2022; 81:567-576. [PMID: 35763059 DOI: 10.1007/s00393-022-01235-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 10/17/2022]
Abstract
Hepatic granulomas can have various causes and their detection requires a systematic diagnostic evaluation. First, identification of risk factors for granulomatous diseases and the exclusion of extrahepatic organ manifestation are necessary. Laboratory investigations and serological screening for the most common underlying diseases of liver granulomas in Germany, such as primary biliary cholangitis (PBC), sarcoidosis and infectious causes (primarily tuberculosis and hepatitis C infections), are recommended. A liver biopsy is essential for confirming the diagnosis, whereby a minilaparoscopically guided tissue sampling offers many advantages, such as the macroscopic detection of granulomas on the liver surface, on the peritoneum or on the spleen. Whether the detection of hepatic granulomas results in a therapeutic consequence, depends decisively on the underlying primary disease. If hepatic granulomas are present without concomitant liver parenchymal damage or other manifestations that would make treatment necessary, a watch and wait approach under close clinical and laboratory monitoring is sufficient. If liver values increase or in cases of hepatic parenchymal damage, urgent treatment of the underlying disease is indicated.
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Affiliation(s)
- Ludwig J Horst
- I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.,Europäisches Referenznetzwerk für seltene Lebererkrankungen (ERN RARE-LIVER), Hamburg, Deutschland
| | - Sören Weidemann
- Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Ansgar W Lohse
- I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.,Europäisches Referenznetzwerk für seltene Lebererkrankungen (ERN RARE-LIVER), Hamburg, Deutschland
| | - Marcial Sebode
- I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland. .,Europäisches Referenznetzwerk für seltene Lebererkrankungen (ERN RARE-LIVER), Hamburg, Deutschland.
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Karaosmanoglu AD, Uysal A, Karcaaltincaba M, Akata D, Ozmen MN, Kraeft J, Hahn PF. Non-neoplastic hepatopancreatobiliary lesions simulating malignancy: can we differentiate? Insights Imaging 2020; 11:21. [PMID: 32040641 PMCID: PMC7010905 DOI: 10.1186/s13244-019-0813-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/28/2019] [Indexed: 01/12/2023] Open
Abstract
Despite the success of cross-sectional imaging in evaluating hepatopancreatobiliary system malignancies, several non-malignant disease processes may closely mimic malignancy. Differentiating these benign diseases from malignancy may be difficult, or even impossible, even in the hands of experienced imagers. In this manuscript, we present benign mimics involving the hepatopancreatobiliary system and try to increase awareness of these potential pitfalls.
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Affiliation(s)
| | - Aycan Uysal
- Department of Radiology, Gulhane Training and Research Hospital, 06010, Ankara, Turkey
| | | | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Jessica Kraeft
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
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Chou CK, Chou SC. Necrotizing granulomatous inflammation of the liver. Radiol Case Rep 2016; 11:157-60. [PMID: 27594940 PMCID: PMC4996915 DOI: 10.1016/j.radcr.2016.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/08/2016] [Accepted: 05/23/2016] [Indexed: 11/24/2022] Open
Abstract
A 73-year-old patient with necrotizing granulomatous inflammation of the liver is presented. The computed tomography demonstrated 2 hypodense tumors with progressive enhancement in the liver. They became nearly isodense to the normal hepatic parenchyma on the delayed phase.
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Affiliation(s)
- Chung Kuao Chou
- Department of Radiology, Yuan’s General Hospital, No. 162, Cheng-Kung 1st Rd., Kaohsiung, Taiwan 80249, Republic of China
| | - Shih-Cheng Chou
- Department of Pathology, Yuan’s General Hospital, No. 162, Cheng-Kung 1st Rd, Kaohsiung, Taiwan 80249, Republic of China
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Wilson PA, Gan L, King S. Granulomatous hepatitis with hepatic mass lesions and a response to infliximab. Intern Med J 2015; 45:783-5. [PMID: 26134699 DOI: 10.1111/imj.12810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/11/2015] [Indexed: 11/29/2022]
Affiliation(s)
- P A Wilson
- Department of General Medicine, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - L Gan
- Department of General Medicine, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.,Department of Gastroenterology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - S King
- Department of Anatomical Pathology, Pathology North, John Hunter Hospital, Newcastle, New South Wales, Australia
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Granulomatous liver diseases: A review. J Formos Med Assoc 2012; 111:3-13. [DOI: 10.1016/j.jfma.2011.11.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 09/19/2011] [Accepted: 11/17/2011] [Indexed: 01/30/2023] Open
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Hepatobiliary and pancreatic MRI and MRCP findings in patients with HIV infection. AJR Am J Roentgenol 2008; 191:228-32. [PMID: 18562750 DOI: 10.2214/ajr.07.3197] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The purpose of this article is to describe the spectrum of MRI and MR cholangiopancreatography (MRCP) findings of hepatic, pancreatic, and biliary manifestations in patients with HIV infection. CONCLUSION The spectrum of MRI and MRCP findings in HIV-infected patients includes acute or chronic hepatitis (or both), pancreatitis, cholangitis, acalculous cholecystitis, and biliary strictures that may resemble primary sclerosing cholangitis. The presence of segmental extrahepatic biliary strictures is characteristic of AIDS cholangiopathy.
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Grazi GL, Vetrone G, Ercolani G, Cescon M, Ravaioli M, Zanello M, Corti B, Pinna AD. Associated benign liver tumors in idiopathic granulomatous hepatitis: A case report. Hepatol Res 2007; 37:568-71. [PMID: 17540000 DOI: 10.1111/j.1872-034x.2007.00082.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We report a unique association of ruptured hepatocellular adenoma, focal nodular hyperplasia and granulomatous hepatitis in a young woman taking oral contraceptives. Diffuse granulomatous hepatitis was found in the liver parenchyma, which was associated with a large granulomatous mass of the left lobe and loco-regional granulomatous lymphadenitis. We cannot give a full explanation of the situation, which represented a challenge in the diagnosis and in the treatment of this patient.
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Affiliation(s)
- Gian Luca Grazi
- Liver and Multi-organ Transplantation, F. Addarii Institute of Oncology, Department of Oncology and Haematology, Sant'Orsola-Malpighi Hopsital, University of Bologna, Bologna, Italy
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Abstract
Recent technologic advances have significantly enhanced the role of imaging in the detection, characterization, and management of infectious diseases involving the liver. In addition, imaging-guided percutaneous drainage has greatly improved the clinical treatment of patients with focal liver abscess. Infectious liver diseases can be accurately evaluated with ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging. Characteristic changes in US echogenicity, CT attenuation, or MR imaging signal intensity and typical enhancement patterns can contribute to the diagnosis of specific infectious diseases, including abscesses, parasitic diseases, fungal diseases, granulomatous diseases, viral hepatitis, and other less common infections. CT is particularly helpful in revealing the presence of calcifications and gas and in detailing the enhancement pattern. The multiplanar capability of MR imaging and its sensitivity to small differences in tissue composition increase its specificity for certain hepatic infections, including hydatid cyst and candidiasis. Radiologic findings may be sufficient to obviate aspiration or histologic examination, although in most instances they are less specific. Nevertheless, imaging findings taken together with appropriate clinical information may provide the most likely diagnosis, even if biopsy is sometimes required for confirmation.
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MESH Headings
- Angiomatosis, Bacillary/diagnostic imaging
- Angiomatosis, Bacillary/pathology
- Animals
- Candidiasis/diagnostic imaging
- Candidiasis/pathology
- Cat-Scratch Disease/diagnostic imaging
- Cat-Scratch Disease/pathology
- Echinococcosis, Hepatic/diagnostic imaging
- Echinococcosis, Hepatic/pathology
- Granuloma/diagnostic imaging
- Granuloma/pathology
- HIV Infections/diagnostic imaging
- HIV Infections/pathology
- Hepatitis/diagnostic imaging
- Hepatitis/pathology
- Hepatitis, Viral, Human/diagnostic imaging
- Hepatitis, Viral, Human/pathology
- Humans
- Liver Abscess/diagnostic imaging
- Liver Abscess/pathology
- Liver Abscess, Amebic/diagnostic imaging
- Liver Abscess, Amebic/pathology
- Magnetic Resonance Imaging
- Schistosomiasis/diagnostic imaging
- Schistosomiasis/pathology
- Tomography, X-Ray Computed
- Tuberculoma/diagnostic imaging
- Tuberculoma/pathology
- Tuberculosis, Hepatic/diagnostic imaging
- Tuberculosis, Hepatic/pathology
- Ultrasonography
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Affiliation(s)
- Koenraad J Mortelé
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
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Abstract
Development of hepatic granulomas, especially those located within portal tracts, is associated with injury to septal and interlobular bile ducts. Dysfunction of the bile ducts in turn leads to cholestasis,and ongoing damage by the granulomatous inflammation eventually results in ductopenia. A multitude of causes of hepatic granulomas have been described over the last few decades. Diligent and prioritized search for cause of hepatic granulomas should proceed within the environmental and epidemiologic context of a given patient. The therapeutic approaches, including amelioration of the cholestatic syndrome, are often determined by successful identification of specific etiologic factors causing the granulomas in the liver.
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Affiliation(s)
- Tonantzin Matheus
- Division of Hepatology, Center for Liver Disease, Liver Transplantation Program, Albert Einstein Medical Center, 5401 Old York Road, Klein Building Suite 509, Philadelphia, PA 19141, USA
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Current awareness in NMR in biomedicine. NMR IN BIOMEDICINE 2002; 15:251-262. [PMID: 11968141 DOI: 10.1002/nbm.748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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