A heterogeneous liver lesion in a 48-year-old woman

Abstract

A 48-year-old woman was admitted to our institution with right upper quadrant abdominal pain. The patient also had mild dyspnea. An examination revealed no significant findings except for a right subcostal surgical incision due to cholecystectomy performed 10 years ago.On performing chest radiography, rise of the right diaphragm to the superior was detected (Figure 1). A hepatobiliary ultrasound examination revealed a mostly cystic lesion with some hyperechoic structures in the liver. On performing contrast-enhanced abdominal computed tomography, a mostly cystic lesion, approximately 15.2×14.2×12.8 cm in diameter, having an appearance similar to the detached membranes of a hydatid cyst and indicating a typical type II hydatid cyst was detected in the liver (Figure 2a). Mediastinal shift and atelectasis of the lower lobe of the right lung were also present (Figure 2b).With a preliminary diagnosis of a type II hydatid cyst, percutaneous treatment was planned to be performed in the interventional radiology department.

Post-Cholecystectomy Gossypiboma Mimicking the Liver Hydatid Cyst

“…On CT it appears as a well-defined mass of heterogeneous attenuation with or without foci of air, wall enhancement, calcification and metallic density object within it. There may be associated perilesional inflammatory changes and abscess formation [3][4][5][6].…”

“…The other foreign body reaction in retained sponge cases involves an exudative inflammatory reaction with abscess formation or chronic internal or external fistula formation. This is believed to be associated with transmural migration of retained sponges [3,4]. Most clinical symptoms are dependent on the gossypiboma location, impact of the inflammatory reaction on adjacent organs; therefore, intestinal obstruction is a frequent clinical presentation.…”

“…Gossypiboma is defined as retained surgical sponge or mass of cotton matrix in peritoneal cavity, organs or in other body compartments after major surgeries [1][2][3]. Retained foreign body is a rare complication after surgical intervention frequently after abdomino-pelvic surgery however, it can also occur rarely after thoracic, orthopedic, urological and neurosurgical procedures [1,3,4]. Most common retained foreign body is surgical sponge [1].…”