Diagnosis of inflammatory pseudotumor of the liver: value of CT.

Abstract

OBJECTiVE.Inflammatory pseudotumor of the liver is a localized mass consisting of a fibrous stroma and chronic inflammatory infiltrate without anaplasia. Diagnosis of this rare disease Is important to avoid surgery. The purpose of this study was to determine if CT is useful in the diagnosis of this lesion.SUBJECTS AND METHODS. CT scans of nine patients with a proved diagnosis of inflammatory pseudotumor of the liver were reviewed. Diagnosis was made by the surgical resection In three patients and by percutaneous biopsy In six patients. Six patients had symptoms and laboratory data suggesting active inflammation caused by the pseudotumor. The remaining three patients were asymptomatic.CT scans were performed with IV administration of the contrast material; scans were obtained in the portal venous and delayed phases In six patients and In the delayed phase In three patients. CT scans were analyzed for the number and size of the hepatic masses, and the degree and pattern of contrast enhancement on portal venous phase and delayedphase images.RESULTS. Eight patients had a solitary hepatic mass, and one patient had two masses on the CT scan. The average size of the masses in the symptomatic patients (8.3 cm) was larger than that in the asymptomatic group (3.6 cm). CT scans In the portal venous phase showed a variable degree of contrast enhancement (seven masses). At least a part of seven masses, six of which were in symptomatic patients, showed greater contrast enhancement on delayed-phase CT scans than on the normal liver parenchyma.No constant pattern of enhancement was observed on delayed-phase CT scans In asymptomatic patients. CONCLUSION.Inflammatory pseudotumor of the liver should be included in a differential diagnosis in patients with a hepatic mass on a CT scan, especially when patients are symptomatic and the mass is fairly large and solitary showing contrast enhancement greater than that of liver parenchyma on delayed-phase CT scans. Percutaneous biopsy should be performed to obtain a histologic confirmation.

Sonazoid-Enhanced Ultrasonography and Ga-EOB-DTPA-Enhanced MRI of Hepatic Inflammatory Pseudotumor: A Case Report

“…Previous studies have noted that delayed-phase CT and fluorodeoxyglucose positron emission tomography do not distinguish hepatic IPT from malignant tumors (16,17). The present case is the first case reported in which the IPT was hypodense at the hepatobiliary phase of Ga-EOB-DTPA-enhanced MRI.…”

Inflammatory pseudotumor of the liver: sonographic and computed tomographic features with complete regression.

“…9,10 Although some reports mention a decrease in the size of the lesions as shown by follow-up imaging studies, we found no other case in the literature with imaging before, during, and after. 8 Moreover, in our follow-up ultrasonographic and CT scans the caudate lobe appears to have shrunk. This may be due to postinflammatory fibrosis and can hypothetically represent the healing process of this lesion.…”

“…This is most likely due to the variable vascularity of the lesion, which ranges from avascular to hypervascular. [7][8][9][10] The ultrasonographic findings of IPT are also variable. Most lesions reported were described as well circumscribed, with either hypoechogenicity or hyperechogenicity.…”

Karaciğerin Mezenkimal Tümörleri

“…Gerçek sebebi bilinmese de enfeksiyon ve biliyer obstrüksiyon en olası sebepler olarak ileri sürülmektedir. Karaciğer IPT'si sıklıkla tek bir soliter (%81), nadiren de multiple (%19) lezyonlar şeklinde gözlenirler [26,27]. Akciğerde gözlenen psödotümörün aksine karaciğer IPT'si epigastrik ağrı, ateş, kusma ve kilo kaybı gibi bir ya da birden çok sistemik semptomla presente olur.…”