Multinodular fatty change in the liver in three patients with chronic hepatic porphyria: Contribution of sonography to the diagnosis

Abstract

We present three cases of chronic hepatic porphyria (CHP) in alcoholic patients, in which grayscale ultrasound (US) revealed multiple echogenic masses in the liver, mimicking multinodular hepatocellular carcinoma on alcoholic liver injury. In all cases, contrast-enhanced US (CEUS) showed iso-enhancement of the mass lesions throughout all vascular phases. Additionally, twodimensional shear wave elastography (2DSWE) (performed in two cases) revealed the mass to have almost the same SWE value as the surrounding parenchyma. When encountering alcoholic patients with multiple echogenic masses in the liver, CHP must be included in the differential diagnosis. CEUS and 2DSWE allow us to increase our diagnostic confidence of CHP. K E Y W O R D S chronic hepatic porphyria, contrast-enhanced ultrasound, elastography, liver

Multiple focal fatty changes in the liver in patients with porphyria cutanea tarda: A case series and review of the literature

“…Naganuma et al hypothesized that patients with hyperechoic rims had less fatty changes than those with a homogeneous hyperechoic pattern. 25 It was also confirmed that in many cases, there was partial confluence and no mass effect in the vascular structures, which suggests that these nodules occur due to degeneration rather than tumors. Furthermore, the irregular pattern of fat deposition observed in Case 4, called "geographic" fatty liver, indicates that PCT can lead to various forms of fat deposition.…”

“…Multiple hyperechoic nodules due to focal steatosis are important as diagnostic triggers for PCT and for differential disease from cancer. Many reports have shown that focal fatty changes can present as multiple hyperechoic nodules in the liver in patients with PCT 5,6,9–25 . However, the incidence of liver nodules in patients with PCT is unknown, and it is possible that some patients with PCT may not have been diagnosed.…”

“…We summarized the clinical and US findings of patients with PCT based on previously reported cases. Twenty‐five cases were selected from 18 previous reports for the analysis 5,9–25 . Some of the previous reports indicated a diagnosis as chronic hepatic porphyria instead of PCT; however, on confirming the diagnostic criteria of each case, they were judged to have PCT.…”

“…PCT. 5,6,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] However, the incidence of liver nodules in patients with PCT is unknown, and it is possible that some patients with PCT may not have been diagnosed. In all seven cases, urinary porphyrin levels were measured for the first time following the detection of multiple hyperechoic lesions, leading to the diagnosis of PCT.…”

“…Twenty-five cases were selected from 18 previous reports for the analysis. 5,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Some of the previous reports indicated a diagnosis as chronic hepatic porphyria instead of PCT; however, on confirming the diagnostic criteria of each case, they were judged to have PCT. We reviewed these 32 cases, including seven of our cases, and have summarized their findings in Table 3.…”