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Pham AT, Dang QH, Dang KK, Nguyen ATM, Truong CM, Nguyen KT. Extrahepatic biliary tract tuberculosis: A case report and literature review. Int J Surg Case Rep 2024; 118:109602. [PMID: 38608518 PMCID: PMC11017269 DOI: 10.1016/j.ijscr.2024.109602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/27/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION Tuberculosis is a chronic infectious disease that often has a latent period after the initial infection. Tuberculosis most often affects the lungs but it can also affect other parts of the body. Vietnam is in pandemic area of tuberculosis. CASE REPORT We present a rare case of a 42-year-old male patient admitted to the hospital with a history of progressive jaundice. Magnetic resonance imaging (MRI) revealed a 26 × 33 mm tuberculous mass located at the intersection between the cystic duct and the common hepatic duct, leading to dilation of the intrahepatic biliary ducts on both sides. Initially diagnosed with a Klatskin type II tumor, the patient underwent surgery to remove the mass and create a biliary-enteric anastomosis. However, the pathological report of the postoperative specimens concluded a diagnosis of necrotizing granulomatous inflammation caused by tuberculosis. CASE DISCUSSION Obstructive jaundice secondary to tuberculosis is a rare condition that can be caused due to the tuberculous enlargement of the pancreatic head, tuberculous lymphadenitis, tuberculous biliary strictures, or a tuberculous retroperitoneal mass. Extrapulmonary tuberculosis usually results from hematogenous dissemination or contiguous spread from adjacent organs. Symptoms vary depending on the affected organ but typically include fever, fatigue, and weight loss. Hepatobiliary tuberculosis is usually secondary to pulmonary or gastrointestinal tuberculosis. CONCLUSION Hepatobiliary tuberculosis is a rare disease that affects the liver and bile duct system. It is difficult to diagnose because it does not have any specific symptoms and can be easily misdiagnosed with other diseases.
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Affiliation(s)
- Anh The Pham
- Department of Hepatobiliary Surgery, Vietnam National Cancer Hospital, Hanoi 100000, Viet Nam
| | | | - Khue Kim Dang
- College of Health Sciences, VinUniversity, Hanoi, 100000, Viet Nam.
| | - An Thi My Nguyen
- College of Health Sciences, VinUniversity, Hanoi, 100000, Viet Nam
| | - Cuong Manh Truong
- Department of Hepatobiliary Surgery, Vietnam National Cancer Hospital, Hanoi 100000, Viet Nam
| | - Khuyen Thi Nguyen
- Department of Pathology, Vietnam National Cancer Hospital, Hanoi 100000, Viet Nam
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Mironova M, Gopalakrishna H, Rodriguez Franco G, Holland SM, Koh C, Kleiner DE, Heller T. Granulomatous liver diseases. Hepatol Commun 2024; 8:e0392. [PMID: 38497932 PMCID: PMC10948139 DOI: 10.1097/hc9.0000000000000392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/18/2023] [Indexed: 03/19/2024] Open
Abstract
A granuloma is a discrete collection of activated macrophages and other inflammatory cells. Hepatic granulomas can be a manifestation of localized liver disease or be a part of a systemic process, usually infectious or autoimmune. A liver biopsy is required for the detection and evaluation of granulomatous liver diseases. The prevalence of granulomas on liver biopsy varies from 1% to 15%. They may be an incidental finding in an asymptomatic individual, or they may represent granulomatous hepatitis with potential to progress to liver failure, or in chronic disease, to cirrhosis. This review focuses on pathogenesis, histological features of granulomatous liver diseases, and most common etiologies, knowledge that is essential for timely diagnosis and intervention.
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Affiliation(s)
- Maria Mironova
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Harish Gopalakrishna
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Gian Rodriguez Franco
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Steven M. Holland
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Christopher Koh
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - David E. Kleiner
- Department of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Theo Heller
- Translational Hepatology Section, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
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3
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Esguerra-Paculan MJA, Soldera J. Hepatobiliary tuberculosis in the developing world. World J Gastrointest Surg 2023; 15:2305-2319. [PMID: 37969705 PMCID: PMC10642457 DOI: 10.4240/wjgs.v15.i10.2305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/31/2023] [Accepted: 08/15/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Hepatobiliary tuberculosis is a challenging disease that poses diagnostic difficulties due to its resemblance to other etiologies. Delayed diagnosis may lead to inadequate treatment, thus necessitating an urgent need for accurate diagnosis and appropriate management. AIM To systematically review case reports on hepatobiliary tuberculosis, focusing on symptomatology, diagnostic procedures, management, and outcomes to provide patient safety and ensure an uneventful recovery. METHODS A systematic search was conducted on PubMed from 1992 to 2022, using keywords such as hepatobiliary, liver, tuberculosis cholangitis, cholangiopathy, and mycobacterium. Only case reports or case series in English were included in the study, and research papers published as abstracts were excluded. The search yielded a total of 132 cases, which were further narrowed down to 17 case studies, consisting of 24 cases of hepatobiliary tuberculosis. RESULTS The 10 most common symptoms observed in these cases were fever, abdominal pain, weight loss, jaundice, anorexia, generalized weakness, pruritus, chills, fatigue, and chest pains. Objective findings in these cases included hepatomegaly, hepatic nodules, elevated liver enzymes, and elevated bilirubin. Computed tomography scan and ultrasound of the abdomen were the most useful diagnostic tools reported. Histologic demonstration of Mycobacterium tuberculosis confirmed the cases of hepatobiliary tuberculosis. Treatment regimens commonly used included Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol. Out of the 24 cases, 18 presented improvements while 4 had completely recovered. CONCLUSION Hepatobiliary tuberculosis is a disease that requires accurate diagnosis and appropriate management to avoid complications.
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Affiliation(s)
| | - Jonathan Soldera
- Acute Medicine, University of South Wales, Cardiff CF37 1DL, United Kingdom
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Das CJ, Rednam N, Vora Z, Aggarwal A, Chandrashekhara SH, Kundra V. Abdominal visceral tuberculosis: a malignancy mimic. Abdom Radiol (NY) 2023; 48:2705-2715. [PMID: 37204509 PMCID: PMC10197054 DOI: 10.1007/s00261-023-03939-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/20/2023]
Abstract
The purpose is to discuss abdominal tuberculosis mimicking malignancy involving the abdominal viscera. TB of the abdominal viscera is common, especially in countries where tuberculosis is endemic and in pockets of non-endemic countries. Diagnosis is challenging as clinical presentations are often non-specific. Tissue sampling may be necessary for definitive diagnosis. Awareness of the early and late disease imaging appearances of abdominal tuberculosis involving the viscera that can mimic malignancy can aid detecting TB, providing a differential diagnosis, assessing extent of spread, guiding biopsy, and evaluating response.
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Affiliation(s)
- Chandan J. Das
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029 India
| | - Nikita Rednam
- Department of Diagnostic Radiology and Nuclear Medicine, Program in Experimental Therapeutics, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201 USA
| | - Zainab Vora
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029 India
| | - Ankita Aggarwal
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029 India
| | - S. H. Chandrashekhara
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029 India
| | - Vikas Kundra
- Department of Diagnostic Radiology and Nuclear Medicine, Program in Experimental Therapeutics, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201 USA
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5
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Gonzalez HC, Gordon SC. Hepatic Manifestations of Systemic Diseases. Med Clin North Am 2023; 107:465-489. [PMID: 37001948 DOI: 10.1016/j.mcna.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
In addition to being the primary target of infections such as viral hepatitis, the liver may also be affected by systemic disease. These include bacterial, mycotic, and viral infections, as well as autoimmune and infiltrative diseases. These conditions generally manifest as abnormal liver biochemistries, often with a cholestatic profile, and may present with additional signs/symptoms such as jaundice and fever. A high index of suspicion and familiarity with potential causal entities is necessary to guide appropriate testing, diagnosis, and treatment.
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Affiliation(s)
- Humberto C Gonzalez
- Division of Gastroenterology and Hepatology, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI 48202, USA; Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI 48201, USA.
| | - Stuart C Gordon
- Division of Gastroenterology and Hepatology, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI 48202, USA; Wayne State University School of Medicine, 540 E Canfield St, Detroit, MI 48201, USA
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Hao F, Feng Q, Yang X, Wang W. Primary isolated hepatic tuberculosis after resection of cholangiocarcinoma:A case report. Asian J Surg 2022; 46:2116-2117. [PMID: 36535874 DOI: 10.1016/j.asjsur.2022.11.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/11/2022] [Indexed: 12/23/2022] Open
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Abstract
BACKGROUND AND AIMS Hepatic tuberculosis (HTB) is rare and mimics neoplastic liver lesions clinico-radiologically leading to misdiagnosis and even unnecessary surgery. METHODS AND MATERIAL We analysed 43 cases of HTB diagnosed at a referral cancer centre over 10 years. Clinical details, investigations and treatment received were noted. RESULTS The median age was 46 years with a female preponderance (58%). HTB was diagnosed incidentally in 28% cases during surveillance imaging for a previous cancer. Constitutional symptoms (31, 72%), abdominal pain (25, 58%), fever (12, 28%), hepatomegaly (22, 51%), elevated alkaline phosphatase (34, 79%), elevated aminotransferases (18, 42%) and hypoalbuminemia (19, 45%) were common features. All cases had negative HIV serology and normal tumor markers. Twenty-two (52.5%) had solitary liver lesion and lesions > 2 cm in 28 (65%). Ultrasound showed hypoechoic lesions in 31 of 33 cases. Computed tomography showed hypodense lesions (43,100%) with mild peripheral enhancement (32, 74%). Calcifications (5, 12%) and capsular retraction (8, 19%) was uncommon. MRI was performed in seven cases commonly showed T1 hypointense, T2 hyperintense lesions with restricted diffusion. Histopathology showed granulomatous inflammation (42, 97.5%), Langhan's giant cells (41, 95%) and caseation necrosis (35, 85%). Acid-fast stain and PCR positivity was uncommon. Extrahepatic organs were involved in 20 (46.5%). HTB mimicked cholangiocarcinoma (25, 58%), liver metastasis (11, 26%) and lymphoma (3, 7%). Six patients underwent liver resection with a presumptive diagnosis of cancer without a preoperative biopsy. All patients received antitubercular therapy, 37 had clinico-radiological response, there were 3 deaths and 3 patients were lost to follow-up. CONCLUSION HTB is rare and can mimic a malignancy clinico-radiologically. Calcifications and pseudocapsule appearance on multiphase CT scan may help in differentiating HTB from hepatic malignancy. Tumor markers are normal while histopathology is generally diagnostic. A high index of suspicion is required to avoid unnecessary surgery as the patients respond well to ATT. TRIAL REGISTRATION This is a retrospective and observational study hence clinical trial registration is not applicable.
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Miyasaka A, Sato S, Masuda T, Takikawa Y. A 55-Year-Old Japanese Man with Multiple Sclerosis Diagnosed with Disseminated Tuberculosis Identified by Liver Function Abnormalities: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931369. [PMID: 34404756 PMCID: PMC8382023 DOI: 10.12659/ajcr.931369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Patient: Male, 55-year-old
Final Diagnosis: Tuberculosis
Symptoms: Liver
Medication: —
Clinical Procedure: —
Specialty: Infectious Diseases
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Affiliation(s)
- Akio Miyasaka
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Shiwa, Iwate, Japan
| | - Shinichirou Sato
- Department of Gastroenterology, Sato Clinic, Hanamaki, Iwate, Japan
| | - Tomoyuki Masuda
- Department of Pathology, Iwate Medical University School of Medicine, Shiwa, Iwate, Japan
| | - Yasuhiro Takikawa
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Shiwa, Iwate, Japan
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9
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Elhence A, Shalimar. Hepatic Tuberculosis: A Wolf in Sheep's Clothing. J Clin Exp Hepatol 2021; 11:521. [PMID: 34276162 PMCID: PMC8267350 DOI: 10.1016/j.jceh.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
| | - Shalimar
- Address for correspondence: Dr Shalimar, Additional Professor, All India Institute of Medical Sciences, Room No 127, Human Nutrition Unit, 1st Floor, Old O.T. Block, AIIMS, New Delhi, India.
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10
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Hepatic tuberculoma: A challenging diagnosis. Int J Infect Dis 2020; 96:509-510. [DOI: 10.1016/j.ijid.2020.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 11/20/2022] Open
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Beyond pyogenic liver abscess: a comprehensive review of liver infections in emergency settings. Emerg Radiol 2020; 27:307-320. [PMID: 32052222 DOI: 10.1007/s10140-020-01757-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 02/02/2020] [Indexed: 12/14/2022]
Abstract
Hepatobiliary infections are commonly encountered in emergency settings ranging from common pathology such as pyogenic abscess to relatively uncommon and rare etiologies. Since extensive literature is already available on imaging of more common bacterial infections, for the sake of focused discussion, this review will discuss radiological appearance of less commonly encountered hepatic infections of fungal, parasitic, viral, and tubercular etiologies. Epidemiological and clinical information remain extremely important for obtaining more accurate presumptive diagnosis. In the era of diverse population migration, a modern-era radiologist must be well versed about the imaging spectrum of liver infections.
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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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Malikowski T, Mahmood M, Smyrk T, Raffals L, Nehra V. Tuberculosis of the gastrointestinal tract and associated viscera. J Clin Tuberc Other Mycobact Dis 2018; 12:1-8. [PMID: 31720391 PMCID: PMC6830173 DOI: 10.1016/j.jctube.2018.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 03/10/2018] [Accepted: 04/09/2018] [Indexed: 02/07/2023] Open
Abstract
Tuberculosis involvement of the gastrointestinal tract, peritoneum, and associated viscera is an uncommon but well described entity. While peritoneal tuberculosis and tuberculous enteritis are more common, involvement of the esophagus, stomach, colon, rectum, anus, liver, bile ducts, gallbladder, and pancreas can occur. Diagnosis is challenging as cases often mimic neoplasm or inflammatory bowel disease. In this review we outline the pathogenesis, clinical presentation, diagnostic testing, and treatment strategies pertaining to such cases.
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Affiliation(s)
- Thomas Malikowski
- Department of Internal Medicine, Mayo Clinic 200 First St. SW, Rochester, MN 55905 507-284-2511, United States
| | - Maryam Mahmood
- Division of Infectious Diseases, Mayo Clinic 200 First St. SW, Rochester, MN 55905 507-284-2511, United States
| | - Thomas Smyrk
- Department of Anatomic Pathology, Mayo Clinic 200 First St. SW, Rochester, MN 55905 507-284-2511, United States
| | - Laura Raffals
- Division of Gastroenterology and Hepatology, Mayo Clinic 200 First St. SW, Rochester, MN 55905 507-284-2511, United States
| | - Vandana Nehra
- Division of Gastroenterology and Hepatology, Mayo Clinic 200 First St. SW, Rochester, MN 55905 507-284-2511, United States
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Liver and Bile Duct Infections. DIAGNOSTIC PATHOLOGY OF INFECTIOUS DISEASE 2018. [PMCID: PMC7152297 DOI: 10.1016/b978-0-323-44585-6.00011-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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15
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Narayan KS, Kumar M, Padhi S, Jain M, Ashdhir P, Pokharna RK. Tubercular biliary hilar stricture: A rare case report. Indian J Tuberc 2017; 65:266-267. [PMID: 29933873 DOI: 10.1016/j.ijtb.2017.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 06/09/2017] [Indexed: 11/20/2022]
Abstract
Localized hepatic tuberculosis (TB) with or without bile duct involvement is a rare form of hepatobiliary tuberculosis; accounting for less than 1% of all tuberculous infections. We report an uncommon case of cholestatic jaundice with disseminated TB in an immunocompetent male who presented with simultaneous involvement of liver and biliary system.
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Affiliation(s)
- Kumar Shwetanshu Narayan
- Senior Resident, Deptt. of Gastroenterology, Sawai Man Singh (S.M.S.) Medical College and Hospital Jaipur Rajasthan, India
| | - Manoj Kumar
- Senior Resident, Deptt. of Gastroenterology, Sawai Man Singh (S.M.S.) Medical College and Hospital Jaipur Rajasthan, India
| | - Shivdutt Padhi
- Senior Resident, Deptt. of Gastroenterology, Sawai Man Singh (S.M.S.) Medical College and Hospital Jaipur Rajasthan, India
| | - Mukesh Jain
- Assistant Professor, Deptt. of Gastroenterology, Sawai Man Singh (S.M.S.) Medical College and Hospital Jaipur Rajasthan, India
| | - Prachis Ashdhir
- Associate Professor, Deptt. of Gastroenterology, Sawai Man Singh (S.M.S.) Medical College and Hospital Jaipur Rajasthan, India
| | - Rupesh Kumar Pokharna
- Senior Professor, Deptt. of Gastroenterology, Sawai Man Singh (S.M.S.) Medical College and Hospital Jaipur Rajasthan, India.
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Pandya JS, Kandekar RV, Tiwari AR, Kadam R, Adhikari DR. Primary Liver Abscess with Anterior Abdominal Wall Extension Caused by Mycobacteriumtuberculosis Complex. J Clin Diagn Res 2016; 10:PD08-PD09. [PMID: 28050433 DOI: 10.7860/jcdr/2016/21845.8795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 08/27/2016] [Indexed: 11/24/2022]
Abstract
Tubercular liver abscess is generally secondary to some other primary foci in the body, most notably pulmonary and gastrointestinal system. To find primary tubercular liver abscess is rare, with prevalence of 0.34% in patients with hepatic tuberculosis. Abscess tracking into abdominal wall from spinal and para spinal tuberculosis is known, however primary liver tuberculosis rupturing into anterior abdominal wall has been reported only twice in literature. We report a case of 43-year-old female with direct invasion of the anterior abdominal wall from an isolated tubercular parenchymal liver abscess, caused by Mycobacterium tuberculosis complex, diagnosed primarily on smear for Acid Fast Bacilli (AFB), imaging and isolated by culture and BACTEC MGIT 960 KIT. We discuss here the diagnostic dilemma, management and outcome of primary tubercular liver parenchymal abscess with direct invasion into anterior abdominal wall.
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Affiliation(s)
- Jayashri Sanjay Pandya
- Professor, Head of Unit and Trauma Incharge, Department of General Surgery, Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital , Mumbai, Maharashtra, India
| | - Rahul Vilas Kandekar
- Resident, Department of General Surgery, Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital , Mumbai, Maharashtra, India
| | - Ajeet Ramamani Tiwari
- Resident, Department of General Surgery, Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital , Mumbai, Maharashtra, India
| | - Rahul Kadam
- Resident, Department of General Surgery, Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital , Mumbai, Maharashtra, India
| | - Devbrata Radhikamohan Adhikari
- Assistant Professor, Department of General Surgery, Topiwala National Medical College and Bai Yamunabai Laxman Nair Charitable Hospital , Mumbai, Maharashtra, India
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18
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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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19
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Diallo I, Mbengue A, Gning SB, Amar MA, Ndiaye B, Diop Y, Fall F, MBaye PS. Hepatosplenic tuberculosis simulating secondary malignant lesions with cholangitis. BMC Res Notes 2016; 9:316. [PMID: 27324380 PMCID: PMC4915084 DOI: 10.1186/s13104-016-2091-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 05/19/2016] [Indexed: 11/28/2022] Open
Abstract
Background Hepatic and/or splenic tuberculosis may simulate much pathology including malignancies, which can roam the diagnosis. Biopsy is necessary for diagnosis. The treatment allows healing and a cleaning of radiological lesions. Case presentation We report a case of a 48-old-black Senegalese woman, immunocompetent, hospitalized for febrile jaundice and poor general condition. Imaging and hepatic biopsy showed hepatosplenic tuberculosis with cholangitis, simulating secondary malignancies lesions. The outcome was favorable under treatment. Conclusion In front of hepatic nodular lesions simulating malignancies in a tuberculosis endemic areas, achieving a liver biopsy helps rectify the diagnosis.
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Affiliation(s)
- Ibrahima Diallo
- Departement of Internal Medicine and Hepatogastroenterology, Hôpital Principal de Dakar, 1, Avenue Nelson Mandela, BP 3006, Dakar, Sénégal.
| | - Ababacar Mbengue
- Departement of Medical Imaging, Hôpital Principal de Dakar, Dakar, Sénégal
| | - Sara B Gning
- Departement of Internal Medicine and Hepatogastroenterology, Hôpital Principal de Dakar, 1, Avenue Nelson Mandela, BP 3006, Dakar, Sénégal
| | - Mouhamed A Amar
- Departement of Internal Medicine and Hepatogastroenterology, Hôpital Principal de Dakar, 1, Avenue Nelson Mandela, BP 3006, Dakar, Sénégal
| | - Bineta Ndiaye
- Departement of Internal Medicine and Hepatogastroenterology, Hôpital Principal de Dakar, 1, Avenue Nelson Mandela, BP 3006, Dakar, Sénégal
| | - Yankhoba Diop
- Anatomopathology Unit, Hôpital Principal de Dakar, Dakar, Sénégal
| | - Fatou Fall
- Departement of Internal Medicine and Hepatogastroenterology, Hôpital Principal de Dakar, 1, Avenue Nelson Mandela, BP 3006, Dakar, Sénégal
| | - Papa S MBaye
- Departement of Internal Medicine and Hepatogastroenterology, Hôpital Principal de Dakar, 1, Avenue Nelson Mandela, BP 3006, Dakar, Sénégal
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Chaubal N, Joshi M, Bam A, Chaubal R. Contrast-Enhanced Ultrasound of Focal Liver Lesions. Semin Roentgenol 2016; 51:334-357. [PMID: 27743569 DOI: 10.1053/j.ro.2016.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Nitin Chaubal
- Thane Ultrasound Center, Thane (W), MS, India; Jaslok Hospital & Research Centre, Mumbai.
| | - Mukund Joshi
- Thane Ultrasound Center, Thane (W), MS, India; Jaslok Hospital & Research Centre, Mumbai
| | - Anupam Bam
- Thane Ultrasound Center, Thane (W), MS, India
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21
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Iwasaki T, Nagashima A, Nakatsuka H, Ogata N. Localized Hepatic Tuberculosis with Imaging Changes Caused by the Progression of Tuberculosis. Intern Med 2016; 55:613-6. [PMID: 26984077 DOI: 10.2169/internalmedicine.55.5607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Localized hepatic tuberculosis (LHTB) is difficult to diagnose preoperatively, and most cases of LHTB are diagnosed based on pathological findings. A relationship between imaging features and the pathological stage of hepatic tuberculosis (TB) has recently been reported, which could aid in the diagnosis of hepatic TB. We herein present a case study of a patient with LHTB diagnosed postoperatively who demonstrated imaging changes due to the progression of TB. An awareness of the presence of LHTB might have permitted a preoperative diagnosis. This is the first report of an LHTB patient who exhibited imaging changes during the course of the disease.
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22
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Nelwan EJ, Kuniawan J, Praptini MN, Pohan HT. Disseminated tuberculosis diagnosed first as leptospirosis in immunocompetent patient. MEDICAL JOURNAL OF INDONESIA 2015. [DOI: 10.13181/mji.v24i4.1266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Disseminated tuberculosis, mostly seen in immunocompromised patient, can affect several organs. The diagnosis can be difficult due to various clinical manifestations. A case of disseminated tuberculosis of lung and liver that develops acutely is rare especially in immunocompetent patient. Here, we present a 42 year old immunocompetent woman with lung and hepatic tuberculosis which was confirmed by characteristics histopathological findings of the liver biopsy.
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23
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Hickey AJ, Gounder L, Moosa MYS, Drain PK. A systematic review of hepatic tuberculosis with considerations in human immunodeficiency virus co-infection. BMC Infect Dis 2015; 15:209. [PMID: 25943103 PMCID: PMC4425874 DOI: 10.1186/s12879-015-0944-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 04/27/2015] [Indexed: 01/12/2023] Open
Abstract
Background Mycobacterium tuberculosis (TB) infection of the liver, known as hepatic TB, is an extrapulmonary manifestation of TB. Hepatic TB has become more prevalent, likely as a result of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic. We sought to review case series to characterize the epidemiology, pathophysiology, clinical features, diagnosis, and treatment of hepatic TB and to comment on the impact of HIV co-infection on these characteristics. Methods We conducted a systematic literature search in PubMed and ScienceDirect for articles pertaining to hepatic TB with human subjects from 1960 to July 2013. Results We obtained data on 618 hepatic TB patients from 14 case series. The most common reported signs and symptoms were hepatomegaly (median: 80%, range: 10-100%), fever (median: 67%, range: 30–100), respiratory symptoms (median: 66%, range: 32-78%), abdominal pain (median: 59.5%, range: 40-83%), and weight loss (median: 57.5%, range: 20-100%). Common laboratory abnormalities were elevated alkaline phosphatase and gamma-glutamyl transferase. Ultrasound and computerized tomography (CT) were sensitive but non-specific. On liver biopsy, smear microscopy for acid-fast bacilli had a median sensitivity of 25% (range: 0-59%), histology of caseating granulomas had a median sensitivity of 68% (range: 14-100%), and polymerase chain reaction for TB had a median sensitivity of 86% (range: 30-100%). Standard anti-tuberculous chemotherapy for 6 to 12 months achieved positive outcomes for nearly all patients with drug-susceptible TB. Conclusions Clinicians in TB-endemic regions should maintain a high index of suspicion for hepatic TB in patients presenting with hepatomegaly, fever, respiratory symptoms, and elevated liver enzymes. The most sensitive imaging modality is a CT scan, while the most specific diagnostic modality is a liver biopsy with nucleic acid testing of liver tissue samples. Upon diagnosis, 4-drug anti-TB therapy should promptly be initiated. HIV co-infected patients may have more complex cases and should be closely monitored for complications.
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Affiliation(s)
- Andrew J Hickey
- University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201, USA.
| | - Lilishia Gounder
- Department of Infectious Diseases, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa. .,Department of Virology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.
| | - Mahomed-Yunus S Moosa
- Department of Infectious Diseases, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - Paul K Drain
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, USA. .,Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
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24
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Approach to clinical syndrome of jaundice and encephalopathy in tropics. J Clin Exp Hepatol 2015; 5:S116-30. [PMID: 26041951 PMCID: PMC4442860 DOI: 10.1016/j.jceh.2014.05.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 05/14/2014] [Indexed: 12/12/2022] Open
Abstract
A large number of patients present with jaundice and encephalopathy in tropical country like India and acute liver failure is the usual cause. Clinical presentation like ALF is also a complication of many tropical infections, and these conditions may mimic ALF but may have subtle differences from ALF. Moreover, what hepatologists see as acute liver failure in tropics is different from what is commonly described in Western Textbooks. Paracetamol overdose, which is possibly the commonest cause of ALF in UK and USA, is hardly ever seen in India. Most common etiology here is viral hepatitis (hepatitis E > hepatitis B> hepatitis A). Apart from ALF, one may also come across subacute hepatic failure (SAHF) as well as acute-on-chronic liver failure (ACLF) due to viral hepatitis. Interestingly, a host of other conditions can mimic ALF because clinical presentation in these conditions can be dominated by jaundice and encephalopathy. Malarial hepatopathy is possibly the best-known condition out of these and is not an uncommon manifestation of severe malaria. A similar presentation can also be seen in other common infections in tropics such as dengue fever, typhoid fever, leptospirosis, scrub typhus, amoebic liver abscesses, tuberculosis and other bacterial and fungal infections with or without human immunodeficiency virus (HIV) related disease. In many of these conditions, liver failure may not be underlying pathophysiology. Some pregnancy related liver diseases could also present with jaundice and encephalopathy. This review summarizes the commonly seen presentations in tropical country like India, where jaundice and encephalopathy dominate the clinical picture.
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25
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Wiboonchutikul S, Manosuthi W, Kowadisaiburana B, Sungkanuparph S. Diagnostic Value of Percutaneous Liver Biopsy in Fever of Unkown Origin in Patients with Human Immunodeficiency Virus Infection. Jpn J Infect Dis 2015; 68:296-300. [PMID: 25720639 DOI: 10.7883/yoken.jjid.2014.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Fever of unknown origin (FUO) poses a major diagnostic challenge in patients infected with human immunodeficiency virus (HIV). In this retrospective study, we sought to assess the clinical utility of percutaneous liver biopsy as a diagnostic aid for FUO in HIV-infected patients and identify the factors associated with a greater likelihood of a positive diagnostic yield form this procedure. A total of 101 HIV-infected patients with FUO, who had undergone percutaneous liver biopsy in an HIV care hospital, served as the study population. The results obtained from percutaneous liver biopsy were categorized into three groups: (i) diagnostic, (ii) helpful, and (iii) not helpful. Diagnostic and helpful results were classified as useful. The mean (SD) age of patients was 37.6 (6.9) years, and the median (interquartile range [IQR]) CD4 count was 18 (3-62) cells/mm(3). The median (IQR) duration of fever was 20 (8-30) days. Percutaneous liver biopsy was diagnostic in 51 patients (50.5%), helpful in 12 (11.9%) and not helpful in 38 (37.6%) patients. On multivariate analyses, elevation of serum alkaline phosphatase level (OR 1.27 per one time elevation from the upper normal range; 95% CI, 1.03-1.57; P = 0.023), and fever duration of less than 3 weeks (OR 3.82; 95% CI, 1.03-14.18; P = 0.046) was significantly associated with the likelihood of the biopsy findings being classified as useful. Our study supports the case for percutaneous liver biopsy as a useful diagnostic aid in HIV-infected patients with FUO.
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26
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Hoffmann CJ, Hoffmann JD, Kensler C, van der Watt M, Omar T, Chaisson RE, Martinson NA, Variava E. Tuberculosis and hepatic steatosis are prevalent liver pathology findings among HIV-infected patients in South Africa. PLoS One 2015; 10:e0117813. [PMID: 25668620 PMCID: PMC4323253 DOI: 10.1371/journal.pone.0117813] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 01/02/2015] [Indexed: 01/04/2023] Open
Abstract
Liver disease epidemiology in sub-Saharan Africa has shifted as a result of HIV and the increased use of antiretroviral therapy leading to a need for updated data on common causes of liver disease. We retrospectively reviewed records from all hospitalized patients who had liver biopsy at a single hospital in South Africa from 2001 to 2009 and compared diagnosis by HIV status. During the period of study 262 patients had liver biopsy, 108 (41%) were HIV-infected, 25 (10%) were HIV-sero-negative, and 129 (49%) had unknown or unrecorded HIV status. Overall 81% of biopsies provided additional diagnostic data. Malignancy was the most common finding reported on 56 (21%) biopsies followed by granuloma or TB, hepatic steatosis, and fibrosis or cirrhosis. HIV-infected patients were more likely to have granulomas and steatosis. Half of patients with granulomas were already on TB treatment, suggesting paradoxical reactions or drug induced liver injury may have been important causes of liver inflammation among these patients. We note that TB, paradoxical reactions during TB treatment, possible drug induced liver injury, and hepatic steatosis are important causes of liver pathology among HIV-infected hospitalized patients with unclear etiology of liver disease after initial assessment. Among HIV sero-negative patients, malignancy was the major cause of liver disease. Our findings re-enforce the importance of TB as a diagnosis among HIV-infected individuals.
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Affiliation(s)
- Christopher J. Hoffmann
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America
- * E-mail:
| | - Jennifer D. Hoffmann
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Caroline Kensler
- University of Pittsburgh School of Medicine, Pittsburgh, United States of America
| | - Martin van der Watt
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Tanvier Omar
- Department of Anatomical Pathology, University of the Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
| | - Richard E. Chaisson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Neil A. Martinson
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Ebrahim Variava
- Department of Medicine, Klerksdorp Tshepong Hospital Complex and University of the Witwatersrand, Klerksdorp, South Africa
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27
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Jain D, Aggarwal HK, Jain P, Pawar S. Primary hepatic tuberculosis presenting as acute liver failure. Oxf Med Case Reports 2014; 2014:153-5. [PMID: 25988063 PMCID: PMC4370019 DOI: 10.1093/omcr/omu058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 11/02/2014] [Accepted: 12/01/2014] [Indexed: 11/20/2022] Open
Abstract
Abdominal tuberculosis is a common clinical entity in Indian subcontinent; however, hepatic tuberculosis in the absence of miliary abdominal tuberculosis is restricted to the case reports and small case series in English literature. It mimics common liver diseases like liver abscess and tumors. We report a case of 25-year-old immunocompetent female who presented with features of acute liver failure. Ultrasonography (USG) abdomen revealed multiple hypoechoic lesions. However, patient expired within 48 h of presentation but her liver autopsy revealed multiple epithelioid cell caseating granulomas with positive staining for acid fast bacilli (AFB). Polymerase chain reaction (PCR) was also positive for Mycobacterium tuberculosis.
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Affiliation(s)
- Deepak Jain
- Department of Medicine , Pt. B.D. Sharma University of Health Sciences , Rohtak, Haryana , India
| | - H K Aggarwal
- Department of Medicine , Pt. B.D. Sharma University of Health Sciences , Rohtak, Haryana , India
| | - Promil Jain
- Department of Pathology , Pt. B.D. Sharma University of Health Sciences , Rohtak, Haryana , India
| | - Sunil Pawar
- Department of Medicine , Pt. B.D. Sharma University of Health Sciences , Rohtak, Haryana , India
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28
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Shastri M, Kausadikar S, Jariwala J, Dave D, Patell R. Isolated hepatic tuberculosis: An uncommon presentation of a common culprit. Australas Med J 2014; 7:247-50. [PMID: 25031646 PMCID: PMC4082249 DOI: 10.4066/amj.2014.2076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Hepatic tuberculosis (HTB) is commonly encountered in patients with widespread miliary disease. Isolated affection of the liver is extremely rare. We present a case of a young woman who presented with a subacute afebrile hepatic failure. Investigations including a liver biopsy proved that the presentation was due to granulomatous hepatitis secondary to mycobacterial infection of the liver. It is important that tuberculosis (TB) be kept in mind especially in endemic areas even in atypical clinical scenarios by clinicians, radiologists, and pathologists. Use of anti-tuberculous drugs in such cases is usually successful and must be instituted early.
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Affiliation(s)
- Minal Shastri
- Department of Medicine, Medical College Baroda and SSG Hospital, Vadodara, Gujarat, India
| | - Shripad Kausadikar
- Department of Medicine, Medical College Baroda and SSG Hospital, Vadodara, Gujarat, India
| | - Jigar Jariwala
- Department of Medicine, Medical College Baroda and SSG Hospital, Vadodara, Gujarat, India
| | - Dhaval Dave
- Department of Medicine, Medical College Baroda and SSG Hospital, Vadodara, Gujarat, India
| | - Rushad Patell
- Department of Medicine, Medical College Baroda and SSG Hospital, Vadodara, Gujarat, India
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29
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Baik SJ, Yoo K, Kim TH, Moon IH, Cho MS. A case of obstructive jaundice caused by tuberculous lymphadenitis: a literature review. Clin Mol Hepatol 2014; 20:208-13. [PMID: 25032188 PMCID: PMC4099337 DOI: 10.3350/cmh.2014.20.2.208] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 11/07/2012] [Accepted: 11/19/2012] [Indexed: 11/05/2022] Open
Abstract
Obstructive jaundice caused by tuberculous lymphadenitis is a rare manifestation of tuberculosis (TB), with 15 cases having been reported in Korea. We experienced a case of obstructive jaundice caused by pericholedochal tuberculous lymphadenitis in a 30-year-old man. The patient's initial serum total bilirubin level was 21.1 mg/dL. Abdominal computed tomography revealed narrowing of the bile duct by a conglomerated soft-tissue mass involving the main portal vein. Abrupt obstruction of the common bile duct was observed on cholangiography. Pathologic analysis of a ultrasonography-guided biopsy sample revealed chronic granulomatous inflammation, and an endoscopic examination revealed esophageal varices and active duodenal ulceration, the pathology of which was chronic noncaseating granulomatous inflammation. Hepaticojejunostomy was performed and pathologic analysis of the conglomerated soft-tissue mass revealed chronic granulomatous inflammation with caseation of the lymph nodes. Tuberculous lymphadenitis should be considered in patients presenting with obstructive jaundice in an endemic area.
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Affiliation(s)
- Su Jung Baik
- Department of Internal Medicine, Health Promotion Center, Yonsei University Gangnam Severance Hospital, Seoul, Korea
| | - Kwon Yoo
- Department of Internal Medicine, Ewha Woman's University School of Medicine, Seoul, Korea
| | - Tae Hun Kim
- Department of Internal Medicine, Ewha Woman's University School of Medicine, Seoul, Korea
| | - Il Hwan Moon
- Department of Internal Medicine, Ewha Woman's University School of Medicine, Seoul, Korea
| | - Min-Sun Cho
- Department of Pathology, Ewha Woman's University School of Medicine, Seoul, Korea
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30
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Shah U. Infections of the Liver. DISEASES OF THE LIVER IN CHILDREN 2014. [PMCID: PMC7121352 DOI: 10.1007/978-1-4614-9005-0_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
The portal vein carries blood from the gastrointestinal tract to the liver and in so doing carries microbes as well. The liver may therefore be involved in infections with a myriad number of microbial organisms. While some of these infections most commonly occur in the immunocompromised host, others affect the immune competence. Hepatic infections may be primary in nature or secondary, as part of systemic or contagious disease. The purpose of this chapter is to provide a brief overview of the various infections of the liver in the pediatric patient.
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31
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Shen Z, Liu H. Pancreatobiliary and peripancreatobiliary tuberculosis: a rare cause of obstructive jaundice. Arch Med Sci 2013; 9:1152-7. [PMID: 24482664 PMCID: PMC3902729 DOI: 10.5114/aoms.2013.39799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 05/13/2011] [Accepted: 07/03/2011] [Indexed: 01/26/2023] Open
Affiliation(s)
- Zhenbin Shen
- Zhongshan Hospital of Fudan University, Shanghai, China
| | - Houbao Liu
- Zhongshan Hospital of Fudan University, Shanghai, China
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32
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Hanafiah M, Alhabshi SMI, Bag T, Low SF. Probable hepatic tuberculosis masquerading as Klatskin tumour in an immunocompetent patient. BMJ Case Rep 2013; 2013:bcr-2013-010262. [PMID: 24343799 DOI: 10.1136/bcr-2013-010262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 55-year-old immunocompetent woman was presented with features of obstructive jaundice and a clinicoradiological picture suggestive of a hilar cholangiocarcinoma (Klatskin tumour). However, caseating granulomatous lesion associated with miliary nodules were revealed intraoperatively. The lesion responded to standard antituberculous therapy. This unusual presentation highlights the considerable diagnostic challenge in such case.
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Affiliation(s)
- Mohammad Hanafiah
- Department of Radiology, MARA University of Technology, Sungai Buloh, Selangor, Malaysia
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33
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Srivastava B, Gimson A. Hepatic changes in systemic infection. Best Pract Res Clin Gastroenterol 2013; 27:485-95. [PMID: 24090937 DOI: 10.1016/j.bpg.2013.06.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 06/23/2013] [Indexed: 01/31/2023]
Abstract
Liver is an integral part of the host-defense mechanism and facilitates clearance of pathogenic organisms in systemic infection by modulating the immunological response. It undergoes several cellular and molecular changes resulting in the release of pro-inflammatory cytokines, which regulate various metabolic and immunological signalling pathways. Some of these changes are pathogen-specific and essential in determining the host response to systemic infection. However, alterations in the immunological homeostasis can adversely affect the liver and lead to hepatic dysfunction. This article focuses on these molecular and immunological changes that occur within the liver in response to extra-hepatic systemic infection and its consequences.
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34
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Bosch W, Poowanawittayakom N, Chaikriangkrai K, Mendez J, Hellinger W, Gonwa T, Krishna M, Pungpapong S. Tuberculous hepatitis in renal transplant recipients following alemtuzumab induction therapy. Transpl Infect Dis 2012; 15:E33-9. [DOI: 10.1111/tid.12048] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Revised: 10/01/2012] [Accepted: 10/15/2012] [Indexed: 02/04/2023]
Affiliation(s)
- W. Bosch
- Division of Infectious Disease; Mayo Clinic; Jacksonville; Florida; USA
| | | | - K. Chaikriangkrai
- Department of Medicine; Siriraj Hospital; Mahidol University; Bangkok; Thailand
| | - J. Mendez
- Division of Infectious Disease; Mayo Clinic; Jacksonville; Florida; USA
| | - W.C. Hellinger
- Division of Infectious Disease; Mayo Clinic; Jacksonville; Florida; USA
| | - T.A. Gonwa
- Department of Transplantation; Mayo Clinic; Jacksonville; Florida; USA
| | - M. Krishna
- Department of Pathology; Mayo Clinic; Jacksonville; Florida; USA
| | - S. Pungpapong
- Department of Transplantation; Mayo Clinic; Jacksonville; Florida; USA
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35
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Duigenan S, Anupindi SA, Nimkin K. Imaging of multifocal hepatic lesions in pediatric patients. Pediatr Radiol 2012; 42:1155-68; quiz 1285. [PMID: 22565297 DOI: 10.1007/s00247-012-2400-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 02/25/2012] [Accepted: 03/05/2012] [Indexed: 02/08/2023]
Abstract
Imaging plays a vital role in detection and characterization of multifocal liver lesions in children. Numerous causes for these lesions exist, including benign and malignant neoplasms, infectious lesions, and congenital and inflammatory conditions. The imaging spectrum of multifocal liver lesions in children is presented with emphasis on key imaging features, differential diagnoses and helpful relevant clinical features.
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Affiliation(s)
- Shauna Duigenan
- Division of Pediatric Radiology, Massachusetts General Hospital, Boston, MA, USA.
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36
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Senthil Kumar MP, Marudanayagam R. Klatskin-like lesions. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2012; 2012:107519. [PMID: 22811587 PMCID: PMC3395250 DOI: 10.1155/2012/107519] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 05/08/2012] [Indexed: 12/20/2022]
Abstract
Hilar cholangiocarcinoma, also known as Klatskin tumour, is the commonest type of cholangiocarcinoma. It poses unique problems in the diagnosis and management because of its anatomical location. Curative surgery in the form of major hepatic resection entails significant morbidity. About 5-15% of specimens resected for presumed Klatskin tumour prove not to be cholangiocarcinomas. There are a number of inflammatory, infective, vascular, and other pathologies, which have overlapping clinical and radiological features with a Klatskin tumour, leading to misinterpretation. This paper aims to summarise the features of such Klatskin-like lesions that have been reported in surgical literature.
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Affiliation(s)
- M. P. Senthil Kumar
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham B15 2TH, UK
- Department of HPB Surgery and Liver Transplantation, Queen Elizabeth Hospital Birmingham, 3rd Floor Nuffield House, Edgbaston, Birmingham B15 2TH, UK
| | - R. Marudanayagam
- The Liver Unit, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham B15 2TH, UK
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37
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Ray S, Chatterjee S, Saha AK, Samanta S. Obstructive Jaundice Due to Tuberculosis of Distal CBD and Periampullary Region Mimickcholangiocarcinoma. Niger J Surg 2012; 18:17-8. [PMID: 24027386 PMCID: PMC3716243 DOI: 10.4103/1117-6806.95478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abdominal tuberculosis (TB) commonly affects the intestinal tract, lymph nodes, peritoneum, and solid organs in varying combinations. Hepatobiliary or pancreatic TB is rare and the preoperative diagnosis is difficult. Though rare, there have been a few citations of intrahepatic tuberculosis, but isolated bile duct tuberculosis is extremely rare. Here we report a case of obstructive jaundice which was initially thought to be due to lower-end cholangiocarcinoma but postoperatively it was found to be tuberculosis.
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Affiliation(s)
- Sumantra Ray
- Nil Ratan Sirrcar Medical College and Hospital, Kolkata, India
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38
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Lee WK, Van Tonder F, Tartaglia CJ, Dagia C, Cazzato RL, Duddalwar VA, Chang SD. CT appearances of abdominal tuberculosis. Clin Radiol 2011; 67:596-604. [PMID: 22212637 DOI: 10.1016/j.crad.2011.11.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 11/06/2011] [Indexed: 12/16/2022]
Abstract
The purpose of this article is to review and illustrate the spectrum of computed tomography (CT) appearances of abdominal tuberculosis. Tuberculosis can affect any organ or tissue in the abdomen, and can be mistaken for other inflammatory or neoplastic conditions. The most common sites of tuberculosis in the abdomen include lymph nodes, genitourinary tract, peritoneal cavity and gastrointestinal tract. The liver, spleen, biliary tract, pancreas and adrenals are rarely affected, but are more likely in HIV-seropositive patients and in miliary tuberculosis. This article should alert the radiologist to consider abdominal tuberculosis in the correct clinical setting to ensure timely diagnosis and enable appropriate treatment.
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Affiliation(s)
- W-K Lee
- Department of Medical Imaging, University of Melbourne, Fitzroy, Victoria, Australia.
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39
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Hsieh TC, Wu YC, Hsu CN, Yang CF, Chiang IP, Hsieh CY, Sun SS, Kao CH. Hepatic Macronodular Tuberculoma Mimics Liver Metastasis in a Patient With Locoregional Advanced Tongue Cancer. J Clin Oncol 2011; 29:e641-3. [PMID: 21606414 DOI: 10.1200/jco.2011.34.9407] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Te-Chun Hsieh
- China Medical University Hospital; and China Medical University, Taichung, Taiwan
| | - Yu-Chin Wu
- China Medical University Hospital; and China Medical University, Taichung, Taiwan
| | | | | | | | | | - Shung-Shung Sun
- China Medical University Hospital; and China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- China Medical University Hospital; and China Medical University, Taichung, Taiwan
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Mansoor T, Rizvi SAA, Khan RA. Persistent port-site sinus in a patient after laparoscopic cholecystectomy: watch out for gallbladder tuberculosis. Hepatobiliary Pancreat Dis Int 2011; 10:328-9. [PMID: 21669580 DOI: 10.1016/s1499-3872(11)60055-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The gallbladder is rarely affected by mycobacterium tuberculosis. The diagnosis of gallbladder tuberculosis is often not suspected prior to surgery or biopsy. METHOD A young female patient underwent laparoscopic cholecystectomy but presented with a persistently discharging sinus from the port site. RESULTS The gallbladder biopsy revealed granulomas typical of chronic granulomatous tuberculosis. The condition of the patient was improved by antitubercular treatment. CONCLUSIONS Presentation of gallbladder tuberculosis as a persistent discharging sinus at the port site in a patient who has undergone a laparoscopic cholecystectomy is extremely rare. The diagnosis was reached by histopathology only. The rarity of the presentation prompted us to report the case.
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Affiliation(s)
- Tariq Mansoor
- Department of Surgery, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, India
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Abe K, Aizawa T, Maebayashi T, Nakayama H, Sugitani M, Sakaguchi M, Shizukuishi T, Yano K, Takayama T, Takahashi M. Isolated tuberculous liver abscess invading the abdominal wall: Report of a case. Surg Today 2011; 41:741-4. [DOI: 10.1007/s00595-010-4333-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2009] [Accepted: 01/04/2010] [Indexed: 11/28/2022]
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Rodríguez-Framil M, Antela A, Prieto A, Otero E, Molina E, Varo E. Tuberculous hepatic abscess appearing after liver transplantation in a patient with human immunodeficiency virus and hepatitis B and C virus co-infection. Transpl Infect Dis 2011; 13:515-9. [DOI: 10.1111/j.1399-3062.2011.00620.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Abstract
The liver plays an important role in host defense against invasive microorganisms. The effect of microbial pathogens on the liver can vary greatly, presenting with a wide variety of manifestations from asymptomatic increases in aminotransaminases, acute liver failure, hepatic fibrosis, and cirrhosis. In evaluating the liver manifestations of a potential infectious pathogen, diagnosis of some of the less common infectious pathogens is dependent on a high level of suspicion and recognition of some of the key diagnostic clues. Successful diagnosis can only be accomplished through a careful history, including travel and exposures, physical examination, and appropriate microbiologic studies. This article reviews the involvement of the liver during systemic infections with organisms that are not considered to be primarily hepatotropic.
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Affiliation(s)
- Rohit Talwani
- Assistant Professor of Medicine, Institute of Human Virology, Division of Infectious Diseases, Department of Medicine, University of Maryland School of Medicine, Baltimore MD
| | - Bruce L. Gilliam
- Associate Professor of Medicine, Institute of Human Virology, Division of Infectious Diseases, Department of Medicine, University of Maryland School of Medicine, Baltimore MD
| | - Charles Howell
- Profesor of Medicine, Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore MD
- Director of Hepatology Research University of Maryland School of Medicine, Baltimore, MD
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Abstract
Chronic liver disease is associated with many pulmonary complications. Several, including hepatopulmonary syndrome, portopulmonary hypertension, and hepatic hydrothorax have been extensively reviewed. However, hepatobiliary manifestations of primary pulmonary diseases have received less attention. This review focuses on hepatobiliary complications of respiratory failure, cystic fibrosis, α-1 antitrypsin deficiency, sarcoidosis, and tuberculosis.
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Affiliation(s)
- Rajan Kochar
- Division of Gastroenterology, Hepatology and Nutrition, The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.234, Houston, TX 77030, USA
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Frederiksen HB, Kragstrup J, Dehlholm-Lambertsen B. Attachment in the doctor-patient relationship in general practice: a qualitative study. Scand J Prim Health Care 2010; 28:185-90. [PMID: 20642396 PMCID: PMC3442335 DOI: 10.3109/02813432.2010.505447] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 06/29/2010] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To explore why interpersonal continuity with a regular doctor is valuable to patients. DESIGN, SETTING, AND SUBJECTS A qualitative study based on 22 interviews with patients, 12 who saw their regular general practitioner (GP) and 10 who saw an unfamiliar GP. The patients were selected after an observed consultation and sampled purposively according to reason for encounter, age, and sex. The research question was answered by means of psychological theory. RESULTS A need for attachment was a central issue for the understanding of the value of interpersonal continuity for patients. The patients explained that they preferred to create a personal relationship with their GP and the majority expressed a degree of vulnerability in the doctor-patient relationship. The more sick or worried they were the more vulnerable and the more in need of a regular GP. Furthermore, patients stated that it was difficult for them to change GP even if they had a poor relationship. CONCLUSION Attachment theory may provide an explanation for patients' need to see a regular GP. The vulnerability of being a patient creates a need for attachment to a caregiver. This need is fundamental and is activated in adults when they are sick or scared.
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Affiliation(s)
- Heidi Bøgelund Frederiksen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark.
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Cao BS, Li XL, Li N, Wang ZY. The nodular form of hepatic tuberculosis: contrast-enhanced ultrasonographic findings with pathologic correlation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:881-888. [PMID: 20498462 DOI: 10.7863/jum.2010.29.6.881] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The purposes of this study were to describe the ultrasonographic findings in hepatic tuberculosis (TB) after administration of a second-generation sulfur hexafluoride-filled microbubble contrast agent and to correlate these findings with pathologic characteristics. METHODS Twenty-four hepatic TB lesions in 15 patients were studied with conventional ultrasonography (CUS) and contrast-enhanced ultrasonography (CEUS). Pathologic characteristics of the lesions were evaluated and were then correlated with enhancement patterns. RESULTS The appearance of hepatic TB on CUS was variable and nonspecific with respect to the shape, echogenicity, and boundary of the lesions. The diameters of the lesions obtained from CEUS were statistically larger than those from CUS, with largest diameters +/- SD of 4.2 +/- 1.8 and 3.1 +/- 1.9 cm, respectively. During the arterial phase, 13 of 24 lesions (54.2%) showed a rapidly and markedly enhanced rim with a hypoenhanced or nonenhanced center; 9 of 24 lesions (37.5%) showed transient enhancement of the whole lesion with inconsistent intensities. During the portal phase, most lesions showed distinct wash-out of the contrast agent and maintained a hypoechoic appearance. Pathologic studies confirmed that the different appearances of hepatic TB on CEUS were related to the different pathologic stages of the lesions. CONCLUSIONS Findings of hepatic TB on CEUS may be helpful in differentiating the diagnosis from other hepatic focal lesions. Correlation with pathologic findings would enrich the understanding of CEUS findings in hepatic TB.
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Affiliation(s)
- Bing-Sheng Cao
- Department of Ultrasound, Chinese People's Liberation Army 309th Hospital, 17 Heshanhu Rd, 100091 Beijing, China.
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Abstract
Hepatobiliary tuberculosis (HTB) is uncommon and can be difficult to diagnose. We present our experience with HTB (over a 10-year period). Fourteen patients were identified from a total of 1888 cases of tuberculosis (TB) infection during this period. Five patients had isolated organ involvement [hepatic (n=3) and biliary (n=2)], and 9 had multiorgan involvement [2 organs (n=7) and 3 organs (n=2)]. The overall annual incidence ranged from 0.0% to 1.05% of all TB infections. Common clinical presentations were weight loss (64%), loss of appetite (64%), abdominal pain (57.1%), fever (50%), jaundice (42.3%), and abdominal distension (14.3%). The median delay from symptom onset to presentation was 40.5 days (range, 7-730 days), and from first presentation to diagnosis was 15 days (range, 1-420 days). Malignancy was initially suspected in 86%. Chest radiographic changes consistent with pulmonary TB were seen in 29% (n=4). Two had active pulmonary TB. Adverse effects of treatment occurred in 42.9%, mainly drug-induced hepatitis and nonspecific gastrointestinal symptoms. Three patients with biliary involvement required long-term biliary stenting. The overall mortality was 14%. In conclusion, HTB is uncommon and is often associated with other organ involvement. Presentation is often delayed, which may lead to significant morbidity and mortality.
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Xu HX, Xie XY, Lu MD, Liu GJ, Xu ZF, Liang JY, Chen LD. Unusual benign focal liver lesions: findings on real-time contrast-enhanced sonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:243-254. [PMID: 18204015 DOI: 10.7863/jum.2008.27.2.243] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE This presentation aims to provide an overview of the manifestations of some unusual benign focal liver lesions (FLLs) on low-acoustic power contrast-enhanced sonography (CES) with a sulfur hexafluoride contrast agent. METHODS The patients were selected retrospectively from 2209 cases with FLLs who had undergone CES examinations for characterization during the past 3 years. The pathologic examinations proved that they were intrahepatic biliary cystadenoma (n = 1), angiomyolipoma (AML; n = 4), lipoma (n = 1), biliary epithelial dysplasia (n = 1), a fungal inflammatory mass (n = 1), tuberculoma (n = 2), an inflammatory pseudotumor (n = 7), sarcoidosis (n = 1), solitary necrotic nodules (n = 2), peliosis hepatis (n = 2), and focal fibrosis after surgery (n = 4). RESULTS Contrast-enhanced sonography was beneficial in leading to a diagnosis of benignity for some lesions showing hyperenhancement during the arterial phase and sustained enhancement during the portal or late phase, such as liver AML and lipoma. The benign nature of other lesions showing no enhancement during all phases, such as solitary necrotic nodules and focal fibrosis, was also suggestible. On the other hand, for those lesions showing hyperenhancement, isoenhancement, or hypoenhancement during the arterial phase and hypoenhancement during the late phase, including intrahepatic biliary cystadenoma, biliary epithelial dysplasia, infected liver diseases, the inflammatory pseudotumor, sarcoidosis, and peliosis hepatis, the differential diagnosis between benignity and malignancy was difficult, and pathologic tests were mandatory. CONCLUSIONS The CES features of unusual benign FLLs may enrich knowledge when performing CES examinations for characterization and may provide clues for a specific diagnosis of an individual lesion such as liver AML.
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Affiliation(s)
- Hui-Xiong Xu
- Department of Medical Ultrasonics, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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Saluja SS, Ray S, Pal S, Kukeraja M, Srivastava DN, Sahni P, Chattopadhyay TK. Hepatobiliary and pancreatic tuberculosis: a two decade experience. BMC Surg 2007. [PMID: 17588265 DOI: 0.1186/1471-2482-7-10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Isolated hepatobiliary or pancreatic tuberculosis (TB) is rare and preoperative diagnosis is difficult. We reviewed our experience over a period two decades with this rare site of abdominal tuberculosis. METHODS The records of 18 patients with proven histological diagnosis of hepatobiliary and pancreatic tuberculosis were reviewed retrospectively. The demographic features, sign and symptoms, imaging, cytology/histopathology, procedures performed, outcome and follow up data were obtained from the departmental records. The diagnosis of tuberculosis was based on granuloma with caseation necrosis on histopathology or presence of acid fast bacilli. RESULTS Of 18 patients (11 men), 11 had hepatobiliary TB while 7 had pancreatic TB. Two-thirds of the patients were < 40 years (mean: 42 yrs; range 19-70 yrs). The duration of the symptoms varied between 2 weeks to 104 weeks (mean: 20 weeks). The most common symptom was pain in the abdomen (n = 13), followed by jaundice (n = 10), fever, anorexia and weight loss (n = 9). Five patients (28%) had associated extra-abdominal TB which helped in preoperative diagnosis in 3 patients. Imaging demonstrated extrahepatic bile duct obstruction in the patients with jaundice and in addition picked up liver, gallbladder and pancreatic masses with or without lymphadenopathy (peripancreatic/periportal). Preoperative diagnosis was made in 4 patients and the other 14 were diagnosed after surgery. Two patients developed significant postoperative complications (pancreaticojejunostomy leak 1 intraabdominal abscess 1) and 3 developed ATT induced hepatotoxicity. No patient died. The median follow up period was 12 months (9-96 months). CONCLUSION Tuberculosis should be considered as a differential diagnosis, particularly in young patients, with atypical signs and symptoms coming from areas where tuberculosis is endemic and preoperative tissue and/or cytological diagnosis should be attempted before labeling them as hepatobiliary and pancreatic malignancy.
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Affiliation(s)
- Sundeep S Saluja
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, New Delhi, India.
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