Spectrum of Pitfalls, Pseudolesions, and Misdiagnoses in Noncirrhotic Liver

Elsayes, Khaled M.; Menias, Christine O.; Morshid, Ali; Shaaban, Akram M.; Fowler, Kathryn J.; Tang, An; Chernyak, Victoria; Szklaruk, Janio; Bashir, Mustafa R.

doi:10.2214/ajr.18.19820

Cited by 6 publications

(6 citation statements)

References 61 publications

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“…However, in the first follow-up after discharge, no lesions were found in the previously aforementioned area, and here show the limitations of CEUS, as in our case it did not characterize it furtherly. It is well documented that there are malignant FLLs and pseudolesions, that mimic benign lesions, such as Cystic Liver Metastases and Metastases with Delayed Phase Enhancement[ 14 ]. Thus a definite diagnosis and classification of the lesion should be the goal.…”

Section: Discussionmentioning

confidence: 99%

Contrast enhanced ultrasound in diagnosing liver lesion that spontaneously disappeared: A case report

Wang¹,

Salameen²,

Gong³

et al. 2021

WJCC

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BACKGROUND Focal liver lesions (FLLs) are abnormal masses that are distinguishable from the surrounding liver parenchyma, solid or cystic and may be benign or malignant. They are usually detected incidentally on abdominal examinations. The classification of FLLs is very important as it directly determines the diagnosis and treatment of patients. CASE SUMMARY A 46-year-old male patient was admitted into the hospital with tarry stool, during the investigation of this issue an incidental FLL was detected. Upon further investigation of this “incidentaloma” computerized tomography and magnetic resonance imaging reached contradictory conclusions. The lesion was then further investigated using contrast-enhanced ultrasound (CEUS) with an initial diagnosis of idiopathic FLL was acquired and observation of the FLL over time need for final diagnosis, however in the follow up the FLL disappeared spontaneously. CONCLUSION CEUSs value for characterization of FLLs is undeniable, especially when other methods produce inconsistent results, is undeniable but with its limitations. Why and how the FLL disappeared is not known, and can be only hypothesized it was a pseudolesion.

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Section: Discussionmentioning

confidence: 99%

Contrast enhanced ultrasound in diagnosing liver lesion that spontaneously disappeared: A case report

Wang¹,

Salameen²,

Gong³

et al. 2021

WJCC

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“…The imaging features of the above tumors overlap with IPT-like FDC tumors, and the first three are the main differential diagnosis. IPTs of the liver usually appears as heterogeneous enhancing tumors with uneven peripheral enhancements[22]. Suspicion should be high for IPT in patients with low grade fever, jaundice, hepatomegaly, weight loss or leukocytosis[23].…”

Section: Discussionmentioning

confidence: 99%

“…Suspicion should be high for IPT in patients with low grade fever, jaundice, hepatomegaly, weight loss or leukocytosis[23]. Typical HCC is characterized by portal phase washout, elevated AFP and threshold growth at follow-up imaging[22,24]. However, atypical HCC is sometimes difficult to distinguish from sarcomas and metastases[24,25].…”

Section: Discussionmentioning

confidence: 99%

Imaging findings of inflammatory pseudotumor-like follicular dendritic cell tumors of the liver: Two case reports and literature review

Li¹,

Liu²,

Guo³

et al. 2019

WJG

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BACKGROUNDInflammatory pseudotumor-like follicular dendritic cell (IPT-like FDC) tumors of the liver is an uncommon tumor with extremely low incidence. To date, the radiologic findings of this tumor in multiphase computed tomography (CT) and magnetic resonance imaging (MRI) imaging have not been described.CASE SUMMARYPatient 1 is a 31-year-old Chinese female, whose complaining incidentally coincided with the finding of multiple liver masses. In the local hospital, an abdominal enhanced CT found two hypo-dense solid lesions, with heterogeneous sustained hypoenhancement, in the upper segment of the liver’s right posterior lobe. In our hospital, enhanced magnetic resonance imaging (MRI) with hepatocyte-specific contrast agents showed a similar enhanced pattern of lesions with patchy hyperintensity in the hepatobiliary phase (HBP). The patient underwent surgery and recovered well. The final pathology confirmed an IPT-like FDC tumor. No recurrence was found on the regular re-examination. Patient 2 is a 48-year-old Chinese male admitted to our hospital for a huge unexpected hepatic lesion. A dynamic enhanced abdominal CT revealed a huge heterogeneous enhanced solid tumor in the right lobe of the liver with a size of 100 mm × 80 mm, which showed a heterogeneous sustained hypoenhancement. In addition, enlarged lymph nodes were found in the hilum of the liver. This patient underwent a hepatic lobectomy and lymph node dissection. The final pathology confirmed an IPT-like FDC tumor. No recurrence was found upon regular re-examination.CONCLUSIONWhen a hepatic tumor shows heterogeneous sustained hypoenhancement with a patchy enhancement during HBP, an IPT-like FDC tumor should be considered in the differential diagnosis.

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“…Two important features that distinguish THEDs from malignancy are a lack of mass effect, as evidenced by vessels coursing through the area unimpeded, and the lack of signal change or altered enhancement on other MRI sequences. Although usually idiopathic, THEDs can arise from other processes, such as hypervascular tumors, abscesses, and vascular thrombosis 59 . When applicable in patients with chronic liver disease, THEDs are classified as LI‐RADS 1 when definite and 2 when probable 24…”

Section: Vascular‐related Lesionsmentioning

confidence: 99%

“…On contrast‐enhanced MRI, third inflow can result in geographic hyperenhancement that can mimic a neoplasm 60 . This is particularly pronounced in patients with superior vena cava obstruction, which results in systemic venous blood being diverted to thoracic and upper abdominal wall collaterals, then in part to the liver via third inflow 59 . When contrast media is injected in an upper‐extremity vein, there is early hyperenhancement of hepatic segment IV, termed the hot quadrate sign on technetium sulfur colloid examinations.…”

Section: Vascular‐related Lesionsmentioning

confidence: 99%

Benign Neoplasms, Mass‐Like Infections, and Pseudotumors That Mimic Hepatic Malignancy at MRI

Costa

Clarke

Stueck

et al. 2020

Magnetic Resonance Imaging

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A variety of conditions may mimic hepatic malignancy at MRI. These include benign hepatic tumors and tumor‐like entities such as focal nodular hyperplasia‐like lesions, hepatocellular adenoma, hepatic infections, inflammatory pseudotumor, vascular entities, and in the cirrhotic liver, confluent fibrosis, and hypertrophic pseudomass. These conditions demonstrate MRI features that overlap with hepatic malignancy, and can be challenging for radiologists to diagnose accurately. In this review we discuss the MRI manifestations of various conditions that mimic hepatic malignancy, and highlight features that may allow distinction from malignancy. Level of Evidence5 Technical Efficacy Stage3

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Spectrum of Pitfalls, Pseudolesions, and Misdiagnoses in Noncirrhotic Liver

Cited by 6 publications

References 61 publications

Contrast enhanced ultrasound in diagnosing liver lesion that spontaneously disappeared: A case report

Contrast enhanced ultrasound in diagnosing liver lesion that spontaneously disappeared: A case report

Imaging findings of inflammatory pseudotumor-like follicular dendritic cell tumors of the liver: Two case reports and literature review

Benign Neoplasms, Mass‐Like Infections, and Pseudotumors That Mimic Hepatic Malignancy at MRI

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