Intratumor Abscess in a Posttraumatic Hepatic Inflammatory Pseudotumor Spreading Out of the Liver

Hayashi, Manabu; Fujita, Masashi; Abe, Kazumichi; Takahashi, Atsushi; Muto, Makoto; Ishigame, Teruhide; Okada, Ryo; Marubashi, Shigeru; Ohira, Hiromasa

doi:10.2169/internalmedicine.5166-20

Cited by 2 publications

(1 citation statement)

References 12 publications

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“…After excluding non-English language written papers, screening, and eligibility, 38 articles were included (Fig. 1 ): 4 cross-sectional studies reporting prevalence data and 34 case reports, for a total of 114 patients [ 1 , 2 , 7 – 16 , 20 – 45 ]. The number of patients in the 4 cross-sectional studies was 13, 19, 23, and 25 [ 7 , 8 , 31 , 45 ].…”

Section: Resultsmentioning

confidence: 99%

Magnetic resonance imaging of inflammatory pseudotumor of the liver: a 2021 systematic literature update and series presentation

et al. 2022

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Purpose Inflammatory pseudotumors of the liver (IPTL) are not exceptional benign lesions with various etiologies, histology, and imaging appearances. The incomplete knowledge of this pathology and the wide polymorphism sometimes resembling malignancy often induce long and expensive diagnostic flow, biopsy and occasionally unnecessary surgery. We propose a systematic revision of MRI literature data (2000–2021) with some narrative inserts and 10 new complete MRI cases, with the aim of organizing the data about IPTL and identifying some typical features able to improve its diagnosis from imaging. Methods We performed a systematic revision of literature from 2000 to 2021 to obtain MRI features, epidemiological, and clinical data of IPTL. The basic online search algorithm on the PubMed database was “(pseudotumor) AND (liver) AND (imaging).” Quality assessment was performed using both scales by Moola for case report studies and by Munn for cross-sectional studies reporting prevalence data. A case-based retrospective study by collecting patients diagnosed with IPTL from three different university hospitals from 2015 to 2021 was done as well. Only cases with MR examinations complete with T1/T2/contrast-enhanced T1/Diffusion-Weighted (W) images and pathology-proven IPTL were selected. Results After screening/selection 38 articles were included for a total of 114 patients. In our experience we selected 10 cases for a total of 16 IPTLs; 8 out of 10 patients underwent at least 1 MRI follow-up. Some reproducible and rather typical imaging findings for IPTL were found. The targetoid aspect of IPTL is very frequent in our experience (75% on T1W, 44% on T2W, 81% on contrast-enhanced T1W (at least one phase), 100% on Diffusion-W images) but is also recurrent in the literature (6% on T1W, 31% on T2W, 51% on CE-T1W (at least one phase), 18% on Diffusion-W images, and 67% on hepatobiliary phase). In our experience, Apparent Diffusion Coefficient map values were always equal to or higher than those of the surrounding parenchyma, and at MRI follow-up, nodule/s disappeared at first/second control, in six patients, while in the remaining 2, lesions persisted with tendency to dehydration. Conclusion A targetoid-like aspect of a focal liver lesion must raise diagnostic suspicion, especially if IgG4-positive plasma is detected. MRI follow-up mainly shows the disappearance of the lesion or its reduction with dehydration. Graphical abstract

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Section: Resultsmentioning

confidence: 99%

Magnetic resonance imaging of inflammatory pseudotumor of the liver: a 2021 systematic literature update and series presentation

et al. 2022

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Clinical and Multimodal Imaging Features of Hepatic Inflammatory Pseudotumors

Chen,

Luo,

et al. 2024

J of Ultrasound Medicine

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ObjectivesCurrent literature on imaging characteristics of hepatic inflammatory pseudotumor (HIPT) is limited. This study aimed to analyze the contrast‐enhanced ultrasound (CEUS) features in HIPT and compare them with contrast‐enhanced computed tomography (CECT) and contrast‐enhanced magnetic resonance imaging (CEMRI).MethodsA total of 83 patients with histologically proven HIPT from two medical institutions were included in this study. All patients underwent CEUS within 1 week before surgery or biopsy. Some patients received additional CECT or CEMRI. B‐mode ultrasound (BMUS) features, enhancement parameters of CEUS, CECT and CEMRI were analyzed. Chi‐square test was used to compare the enhancement patterns and diagnostic sensitivity between CEUS and CECT/CEMRI.ResultsOn the BMUS, HIPT mainly appeared hypoechoic (83.5%, 66/79), irregular shapes (62.0%, 49/79), heterogeneous echogenicity (72.2%, 57/79), and unclear boundary (65.8%, 52/79). A total of 61.5% (51/83) lesions exhibited mild hyper‐ or iso‐enhancement in the arterial phase (AP), 59.0% (49/83) lesions had internal nonenhanced areas, and most lesions (71.1%, 59/83) showed early wash‐out (<60 seconds) on the CEUS. There were significant differences between CEUS and CECT/CEMRI in enhancement intensity of AP and wash‐out pattern (P < .05). The sensitivity in the diagnosis of HIPT among the three had no statistical difference (P>.05).ConclusionsThe CEUS features of HIPT lesions typically include mildly hyper‐enhanced or iso‐enhanced in AP, rapid wash‐out in PVP, and often small nonenhanced areas within the mass. Furthermore, the wash‐out pattern of CEUS and CECT/CEMRI are inconsistent, more akin to cholangiocarcinoma. The diagnostic efficacy of the three modalities is similar.

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Intratumor Abscess in a Posttraumatic Hepatic Inflammatory Pseudotumor Spreading Out of the Liver

Cited by 2 publications

References 12 publications

Magnetic resonance imaging of inflammatory pseudotumor of the liver: a 2021 systematic literature update and series presentation

Magnetic resonance imaging of inflammatory pseudotumor of the liver: a 2021 systematic literature update and series presentation

Clinical and Multimodal Imaging Features of Hepatic Inflammatory Pseudotumors

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