Inflammatory pseudohepatic tumours are unusual tumour-like conditions which can easily be mistaken for malignant lesions or liver abscesses. Patients usually present with fever, abdominal pain and loss of weight. The aetiology is unclear but the predominant inflammatory pattern of pathology and the associated systemic reactions suggest an underlying infectious agent. In the majority, microorganisms are not detected. As even routine imaging procedures usually fail to distinguish hepatic pseudotumours from liver neoplasms, biopsy is the definitive means of diagnosis. Until now, no case of pseudohepatic tumour has been reported as being associated with secondary syphilis. We believe secondary syphilis is the cause of this pseudohepatic tumour in our HIV-positive male.
The near-fatal occurrence of achalasia in a patient with pre-existing bulimia nervosa is described. The case emphasizes the critical importance of being alert to the development of new pathology in individuals with chronic symptoms, especially in the presence of psychological illness. It also raises the possibility of an additional mechanism by which achalasia could be initiated.
Extra-hepatic bile duct compression is encountered commonly among patients with pancreatic disease, primary sclerosing cholangitis, and cholangiocarcinoma. However, in an elderly lady with predominantly cholestatic liver test abnormalities, magnetic resonance cholangiopancreatography (MRCP) demonstrated a large abdominal aortic aneurysm that was causing extra-hepatic bile duct compression and concomitant proximal bile duct dilatation. This unusual and uncommon finding was almost certainly the explanation for her liver test dysfunction. This report draws attention to the increasing role for MRCP as an accurate, but non-invasive means of appraisal of the pancreatico-biliary tree. In addition, an unusual and uncommon cause of extra-hepatic bile duct compression is discussed.
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