Vascular liver injury mimicking an intrahepatic cholangiocarcinoma in a COVID‐19 patient

Ugolotti, M.C. Adorni; Pedrazzini, M; Silini, Enrico Maria; Missale, Gabriele; Silva, Mario; Franzini, Christian; Palmieri, Gerardo; Costi, Roberta; Montali, Filippo; Gnappi, Elisa; Terroni, Lorenza; Colizzi, Elena; Meschi, Michele; Facchinetti, Francesco

doi:10.1002/jmv.26803

Cited by 3 publications

(4 citation statements)

References 11 publications

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“…The patient's SARS-CoV-2 test was also found to be positive and the authors suggested the possibility of AIH flare in this setting. Two other cases have been described in the setting of COVID-19 presenting with symptoms and workup resembling cholangiocarcinoma attributed to viralinduced cholangiopathy and portal vessel damage [24,26]. Finally, recent articles evaluating long COVIDassociated GI symptoms/conditions have proposed alternate mechanisms for their occurrence, such as residual replicative virus particles in GI and hepatic tissues, changes in the gut microbiome, and autoimmune processes, resulting in autonomic dysfunction including POTS-like presentations and/or GERD [19,20,27].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 and Its Sequelae Masquerading as Gastrointestinal Ailments: A Report of Gastroesophageal Reflux Disease (GERD) and Review of Recent Cases

Shweikeh,

Hong,

Rabeeah

et al. 2024

Cureus

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Coronavirus disease 2019 (COVID-19) predominantly causes respiratory symptoms. However, a rare segment of patients recovering from COVID-19 may develop gastrointestinal (GI) symptoms. We describe a case of a female who presented with symptoms suggestive of refractory gastroesophageal reflux disease (GERD) for 18 months following COVID-19 infection. Her symptoms included epigastric and chest pain, coughing, and vomiting. Upper endoscopy and 24-hour pH monitoring were negative. Following hospital admission due to worsening symptoms, she was diagnosed with chronic pulmonary embolism (PE) presumed to be related to COVID-19. Her reflux symptoms resolved within two days of the initiation of anticoagulation. Our findings suggest that chronic PE should be considered in patients presenting with GERD refractory to treatment following COVID-19 infection. Generally, as COVID-19 and its sequelae may masquerade as GI conditions, they should be on the differential diagnosis, especially in the post-pandemic era when routine testing has significantly declined.

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Section: Discussionmentioning

confidence: 99%

COVID-19 and Its Sequelae Masquerading as Gastrointestinal Ailments: A Report of Gastroesophageal Reflux Disease (GERD) and Review of Recent Cases

Shweikeh,

Hong,

Rabeeah

et al. 2024

Cureus

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“…It was hypothesized that the embolic sprouting of floating aortic thrombi caused splenic ischemic lesions. 12 A retrospective study on 12 patients that recovered from severe COVID-19 with serum ALP of three times upper than the normal limit showed that 92% (11/12) of them had a beaded appearance of intrahepatic ducts in MRCP. Unfortunately, five patients who experienced constant jaundice, liver insufficiency, and frequent bacterial cholangitis had been referred for liver transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…However, a liver biopsy showed an inflammatory lesion described by plasma cellular infiltrates and portal‐based confluent lymphohistiocytosis. It was hypothesized that the embolic sprouting of floating aortic thrombi caused splenic ischemic lesions 12 …”

Section: Discussionmentioning

confidence: 99%

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Post‐COVID‐19 syndrome mimicking cholangiocarcinoma: A case report

Khonsari

Boostani

Farnood

2023

Clinical Case Reports

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Although the main impacts of COVID-19 (coronavirus disease 2019) are considered in the pulmonary system, recent studies highlight the liver as the mainly affected organ. Studies show that a significant percentage of COVID-19 patients suffer from hepatic injury, especially patients with critical or severe forms of COVID-19. Major reported pathological changes consist dilatation in the sinusoidal system, infiltration of lymphocytic cells in the sinusoidal system, multifocal hepatic necrosis, Kupffer cell hyperstimulation, and cholestasis. 1 Some fundamental mechanisms have been described for a hepatic malfunction that important causes include lowered blood oxygen saturation due to pneumonia, compromise of cardiac function, direct potential hepatotoxicity from therapeutic drugs (e.g., non-steroidal anti-inflammatory drugs (NSAIDs), hydroxychloroquine, and azithromycin), and cellular injury due to direct viral invasion, and micro and macrovascular changes from hypercoagulability. 2 Aberration in liver function test (LFT) occurs in 14%-53% of COVID-19 patients. 3 Most of these abnormalities in the LFT return to normal condition without specific treatment. Nevertheless, hepatic injuries occur when the LFT is thrice or higher than the normal limit, which may need attentive management. 2 A recent meta-analysis showed that liver vascular thrombosis and portal inflammation occurred in 29.4% and 13.2% of patients with a severe form of This study also showed that progressive ischemic injury in the liver biliary system might rapidly develop in some patients with severe illness, similar to the symptoms seen in the primary sclerosing cholangitis. This

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An Unusual Radiologic Image of Extensive Tumor Mass Infiltrating Hepatic Hilum without Signs of Cholestasis—A Case Report and a Literature Review of Non-Cancerous Lesions Mimicking Intrahepatic Cholangiocarcinoma

Ciesielka,

Jakimów,

Cedrych

et al. 2024

Current Oncology

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Background: Mass-forming intrahepatic cholangiocarcinoma (mICC) is the most frequent type of ICC. In contrast-enhanced computed tomography, mICC is visualized as a hypodense lesion with distal dilatation of intrahepatic bile ducts. The presented case illustrates the unusual manifestation of mICC in a 71-year-old male patient, where despite the extensive tumor mass and the hilar infiltration, the dilatation of intrahepatic bile ducts and cholestasis were not noted. Methods: A literature review on PubMed was performed. Primarily, 547 records were identified, and the titles and abstracts were systematically searched. Regarding the inclusion and exclusion criteria, 31 papers describing the non-cancerous liver lesions mimicking ICC were included in the further analysis. Results: In 41.9% of the analyzed non-cancerous lesions, the obstruction of the bile ducts was not noted, similar to our patient. A significant cholestasis has been found in 30.03% of analyzed patients. The invasion of the liver hilum was noted in one-third of the patients. Conclusions: Atypical radiological features in lesions suspected of ICC, such as the absence of intrahepatic bile-duct dilation, are common in benign lesions. In the case of radiologically atypical lesions suspected of ICC, the diagnostic imaging needs to be correlated with clinical data, and the diagnosis should be confirmed with a pathological examination.

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Vascular liver injury mimicking an intrahepatic cholangiocarcinoma in a COVID‐19 patient

Cited by 3 publications

References 11 publications

COVID-19 and Its Sequelae Masquerading as Gastrointestinal Ailments: A Report of Gastroesophageal Reflux Disease (GERD) and Review of Recent Cases

COVID-19 and Its Sequelae Masquerading as Gastrointestinal Ailments: A Report of Gastroesophageal Reflux Disease (GERD) and Review of Recent Cases

Post‐COVID‐19 syndrome mimicking cholangiocarcinoma: A case report

An Unusual Radiologic Image of Extensive Tumor Mass Infiltrating Hepatic Hilum without Signs of Cholestasis—A Case Report and a Literature Review of Non-Cancerous Lesions Mimicking Intrahepatic Cholangiocarcinoma

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