Contrast-Enhanced Ultrasound LI-RADS LR-5 in Hepatic Tuberculosis: Case Report and Literature Review of Imaging Features
Background: The liver is involved in disseminated tuberculosis in more than 80% of cases while primary liver involvement is rare, representing <1% of all cases. Hepatic tuberculosis (TB) can be treated by conventional anti-TB therapy; however, diagnosing this disease remains a challenge. The diag...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-01-01
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| Series: | Gastroenterology Insights |
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| Online Access: | https://www.mdpi.com/2036-7422/12/1/1 |
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| author | Antonella Forgione Francesco Tovoli Matteo Ravaioli Matteo Renzulli Francesco Vasuri Fabio Piscaglia Alessandro Granito |
| author_facet | Antonella Forgione Francesco Tovoli Matteo Ravaioli Matteo Renzulli Francesco Vasuri Fabio Piscaglia Alessandro Granito |
| author_sort | Antonella Forgione |
| collection | DOAJ |
| description | Background: The liver is involved in disseminated tuberculosis in more than 80% of cases while primary liver involvement is rare, representing <1% of all cases. Hepatic tuberculosis (TB) can be treated by conventional anti-TB therapy; however, diagnosing this disease remains a challenge. The diagnosis might be particularly difficult in patients with a single liver lesion that could be misdiagnosed as a tumor or other focal liver lesions. Although computed tomography (CT) and magnetic resonance imaging (MRI) findings have been described, there is a paucity of literature on contrast-enhanced ultrasound (CEUS) features of hepatic TB. Case Summary: herein, we describe a case of a patient with tuberculous lymphadenopathy and chronic Hepatitis C Virus (HCV)-related liver disease who developed a single macronodular hepatic TB lesion. Due to the finding of a hepatocellular carcinoma (HCC) highly suggestive CEUS pattern, specifically a LR5 category according to the Liver Imaging Reporting and Data System (LI-RADS), and a good response to antitubercular therapy, a non-invasive diagnosis of HCC was made, and the patient underwent liver resection. We also review the published literature on imaging features of hepatic TB and discuss the diagnostic challenge represented by hepatic TB when occurs as a single focal liver lesion. Conclusions: this report shows for the first time that the CEUS pattern of hepatic TB might be misinterpreted as HCC and specific imaging features are lacking. Personal history and epidemiological data are mandatory in interpreting CEUS findings of a focal liver lesion even when the imaging pattern is highly suggestive of HCC. |
| first_indexed | 2024-04-14T07:47:55Z |
| format | Article |
| id | doaj.art-671f7e0f246f49c7bebc424ca04fba4c |
| institution | Directory Open Access Journal |
| issn | 2036-7422 |
| language | English |
| last_indexed | 2024-04-14T07:47:55Z |
| publishDate | 2021-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Gastroenterology Insights |
| spelling | doaj.art-671f7e0f246f49c7bebc424ca04fba4c2022-12-22T02:05:17ZengMDPI AGGastroenterology Insights2036-74222021-01-011211910.3390/gastroent12010001Contrast-Enhanced Ultrasound LI-RADS LR-5 in Hepatic Tuberculosis: Case Report and Literature Review of Imaging FeaturesAntonella Forgione0Francesco Tovoli1Matteo Ravaioli2Matteo Renzulli3Francesco Vasuri4Fabio Piscaglia5Alessandro Granito6Division of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna Via Albertoni 15, 40138 Bologna, ItalyDivision of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna Via Albertoni 15, 40138 Bologna, ItalyDepartment of Medical and Surgical Sciences, University of Bologna, Via Albertoni 15, 40138 Bologna, ItalyRadiology Unit IRCCS Azienda Ospedaliero, Department of Experimental, Diagnostic and Speciality Medicine, University of Bologna, 40138 Bologna, ItalyPathology Division, IRCCS Azienda Ospedaliero, Universitaria di Bologna, 40138 Bologna, ItalyDivision of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna Via Albertoni 15, 40138 Bologna, ItalyDivision of Internal Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna Via Albertoni 15, 40138 Bologna, ItalyBackground: The liver is involved in disseminated tuberculosis in more than 80% of cases while primary liver involvement is rare, representing <1% of all cases. Hepatic tuberculosis (TB) can be treated by conventional anti-TB therapy; however, diagnosing this disease remains a challenge. The diagnosis might be particularly difficult in patients with a single liver lesion that could be misdiagnosed as a tumor or other focal liver lesions. Although computed tomography (CT) and magnetic resonance imaging (MRI) findings have been described, there is a paucity of literature on contrast-enhanced ultrasound (CEUS) features of hepatic TB. Case Summary: herein, we describe a case of a patient with tuberculous lymphadenopathy and chronic Hepatitis C Virus (HCV)-related liver disease who developed a single macronodular hepatic TB lesion. Due to the finding of a hepatocellular carcinoma (HCC) highly suggestive CEUS pattern, specifically a LR5 category according to the Liver Imaging Reporting and Data System (LI-RADS), and a good response to antitubercular therapy, a non-invasive diagnosis of HCC was made, and the patient underwent liver resection. We also review the published literature on imaging features of hepatic TB and discuss the diagnostic challenge represented by hepatic TB when occurs as a single focal liver lesion. Conclusions: this report shows for the first time that the CEUS pattern of hepatic TB might be misinterpreted as HCC and specific imaging features are lacking. Personal history and epidemiological data are mandatory in interpreting CEUS findings of a focal liver lesion even when the imaging pattern is highly suggestive of HCC.https://www.mdpi.com/2036-7422/12/1/1contrast-enhanced ultrasound (CEUS)Liver Imaging Reporting and Data System (LI-RADS)differential diagnosishepatocellular carcinoma (HCC)tuberculosis |
| spellingShingle | Antonella Forgione Francesco Tovoli Matteo Ravaioli Matteo Renzulli Francesco Vasuri Fabio Piscaglia Alessandro Granito Contrast-Enhanced Ultrasound LI-RADS LR-5 in Hepatic Tuberculosis: Case Report and Literature Review of Imaging Features Gastroenterology Insights contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) differential diagnosis hepatocellular carcinoma (HCC) tuberculosis |
| title | Contrast-Enhanced Ultrasound LI-RADS LR-5 in Hepatic Tuberculosis: Case Report and Literature Review of Imaging Features |
| title_full | Contrast-Enhanced Ultrasound LI-RADS LR-5 in Hepatic Tuberculosis: Case Report and Literature Review of Imaging Features |
| title_fullStr | Contrast-Enhanced Ultrasound LI-RADS LR-5 in Hepatic Tuberculosis: Case Report and Literature Review of Imaging Features |
| title_full_unstemmed | Contrast-Enhanced Ultrasound LI-RADS LR-5 in Hepatic Tuberculosis: Case Report and Literature Review of Imaging Features |
| title_short | Contrast-Enhanced Ultrasound LI-RADS LR-5 in Hepatic Tuberculosis: Case Report and Literature Review of Imaging Features |
| title_sort | contrast enhanced ultrasound li rads lr 5 in hepatic tuberculosis case report and literature review of imaging features |
| topic | contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) differential diagnosis hepatocellular carcinoma (HCC) tuberculosis |
| url | https://www.mdpi.com/2036-7422/12/1/1 |
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