Primary isolated hepatic tuberculosis mimicking small hepatocellular carcinoma

Abstract

Rationale: Mycobacterium tuberculosis (TB) remains a serious threat in developing countries. Primary isolated hepatic tuberculosis is extremely rare. Because of its non-specific imaging features, noninvasive preoperative imaging diagnosis of isolated hepatic tuberculoma remains challenging. Patient concerns: A 48-year-old man was admitted to our hospital due for suspected liver neoplasm during health examination. Diagnoses: The tests for blood, liver function, and tumor markers were within normal range. Preoperative ultrasonography (US) showed a hypoechoic lesion with a longitudinal diameter of 2.5 cm in segment six of liver. It exhibited early arterial phase hyperenhancement and late arterial phase rapid washout in contrast-enhanced US. It demonstrated hyperintensity in T2-weighted magnetic resonance imaging and partly restricted diffusion in diffusion-weighted imaging. For this nodule, the preoperative diagnosis was small hepatocellular carcinoma (HCC). Interventions: Laparoscopic hepatectomy was performed. Intraoperative extensive adhesion in the abdominal cavity and liver was found. The lesion had undergone expansive growth. Outcomes: Microscopically, a granuloma with some necrosis was detected. With both acid-fast staining and TB fragment polymerase chain reaction showing positive results, TB was the final histology diagnosis. After surgery, the patient declined any anti-TB medication. During the follow-up, he had no symptoms. In the sixth month after surgery, he underwent an upper abdominal US. It showed no lesions in the liver. Lessons: Because of non-specific imaging findings and non-specific symptoms, a diagnosis of isolated hepatic TB is difficult to make, especially for small lesions. A diagnosis of HCC should be made cautiously when small isolated lesions in the liver are encountered, especially in patients without a history of hepatitis and with negative tumor markers.

Liver Imaging and Data System (LI-RADS) Version 2018 and Other Imaging Features in Intrahepatic Cholangiocarcinoma in Chinese Adults with vs. without Chronic Hepatitis B Viral Infection

“…LI-RADS diagnostic accuracy is a clinically relevant topic because many liver lesions, even hepatic tuberculosis [ 39 , 40 ], can display a contrast-enhanced LI-RADS features resembling HCC. The iCCAs diagnosis might be more challenging in HBV-positive patients due to the overlapping imaging patterns compared with HCC.…”

Isolated Hepatic Tuberculosis: A Difficult Diagnosis

“…However, it has been repeatedly reported that imaging lacks specific features and the likelihood of misdiagnosis is high. [2][3][4] In particular, also the triphasic CT scan and contrastenhanced ultrasound could not correctly identify the TB nature of a focal liver lesion, as recently reported. 4 This is particularly challenging in patients with a single liver lesion that could be misdiagnosed as liver cancer or other focal liver lesions.…”

“…Importantly, TB-specific symptoms are lacking. [2][3][4] In conclusion, we would like to highlight that owing to the lack of specific clinical manifestations and imaging features, a good knowledge of personal history and epidemiological data is mandatory in interpreting imaging findings of a focal liver lesion and for differential diagnosis, especially in patients from TB-endemic areas.…”

Diagnosis of Non-Hepatocellular Carcinoma Malignancies in Patients With Risks for Hepatocellular Carcinoma: CEUS LI-RADS Versus CT/MRI LI-RADS

“…On the one hand, some features for categorization and influencing factors of the image quality were not evaluating in our study, such as threshold growth, depth of lesions and extent of cirrhosis or fatty liver, which may influent the final category. Besides, the current study lacked personal history and epidemiological data of patients, which should be acquired in the future study in order to recognize primary isolated hepatic tuberculosis, a mimic of hepatic malignancies in imaging diagnosis (40,41). On the other hand, our findings may have limited generalizability due to small sample capacity enrolled from single center.…”