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Ren SX, Li PP, Shi HP, Chen JH, Deng ZP, Zhang XE. Imaging presentation and postoperative recurrence of peliosis hepatis: A case report. World J Clin Cases 2021; 9:5197-5202. [PMID: 34307567 PMCID: PMC8283614 DOI: 10.12998/wjcc.v9.i19.5197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/02/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Peliosis hepatis (PH) is a rare benign lesion of vascular origin with a pathological characteristic of multiple blood-filled cavities in the liver parenchyma. It is commonly misdiagnosed due to its lack of specificity in clinical presentation and laboratory test results. Herein, a case of a patient with PH who was misdiagnosed with hepatic echinococcosis before operation to remove the lesions was analyzed, with an emphasis on the computed tomography and magnetic resonance imaging characteristics of PH.
CASE SUMMARY We outline the case of a 40-year-old Chinese female who was admitted with aggravated abdominal pain with fever for 1 wk. Ultrasound examination at the local hospital indicated hepatic echinococcosis. However, discordance between imaging diagnosis, clinical history and laboratory examinations in our hospital. Subsequently, the patient was pathologically confirmed as having PH-like changes, which recurred 1 year after operation removal of the lesion.
CONCLUSION Our objective is to highlight the imaging diagnostic value of PH.
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Affiliation(s)
- Si-Xie Ren
- Department of Radiology, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Pan-Pan Li
- Department of Radiology, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Hai-Peng Shi
- Pathology Center, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Jun-Hui Chen
- Department of Radiology, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Zhen-Ping Deng
- Department of Radiology, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Xi-E Zhang
- Department of Radiology, Chengdu Second People’s Hospital, Chengdu 610000, Sichuan Province, China
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Dong Y, Wang WP, Lim A, Lee WJ, Clevert DA, Höpfner M, Tannapfel A, Dietrich CF. Ultrasound findings in peliosis hepatis. Ultrasonography 2021; 40:546-554. [PMID: 34399044 PMCID: PMC8446485 DOI: 10.14366/usg.20162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/22/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose The aim of this study was to retrospectively evaluate contrast-enhanced ultrasound (CEUS) findings in patients with peliosis hepatis (PH). Methods A retrospective analysis was conducted of CEUS features in 24 patients with histopathologically confirmed PH (11 men and 13 women; mean age, 32.4±7.1 years; range, 28 to 41 years). All lesions were histologically proven, either by core needle biopsy (n=10) or by hepatic surgery (n=14). Results The mean size was 36.8±12.4 mm (range, 10 to 80 mm). On B-mode ultrasonography (BMUS), all PH lesions were heterogeneously hypoechoic, with well-defined margins but irregular shapes. No mass effect was observed. During the arterial phase of CEUS, all lesions displayed mild heterogeneous hyperenhancement (83.3%, 20/24) or isoenhancement (16.7%, 4/24). Furthermore, 87.5% of the PH lesions showed mild washout after 1 minute in the portal venous phase (30-120 seconds) and mild washout in the late phase (>120 seconds). Conclusion The lack of a mass effect on BMUS, mild heterogeneous arterial hyperenhancement, and washout in the very late portal venous phase (after 1 minute) on CEUS are characteristic of PH. Although it is a histological diagnosis, PH should be considered in the differential diagnosis when the clinical context does not favor a malignancy or infection.
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Affiliation(s)
- Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Adrian Lim
- Department of Imaging, Imperial College London and Healthcare NHS Trust, Charing Cross Hospital Campus, London, UK
| | - Won Jae Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Science and Technology and Medical Device Management and Research, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Korea
| | - Dirk-Andre Clevert
- Interdisciplinary Ultrasound-Center, Department of Radiology, University of Munich-Grosshadern Campus, Munich, Germany
| | - Michael Höpfner
- Department Gastroenterologie, Klinik für Innere Medizin, Agaplesion Diakonie Kliniken Kassel, Kassel, Germany
| | | | - Christoph Frank Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Beau Site, Salem und Permanence, Hirslanden, Bern, Switzerland
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Maruyama H, Takahashi K, Ishikawa N, Hosaka K, Kumaki D, Aruga Y, Yamakawa M, Hirano M, Funakoshi K, Terai S. A rare case of peliosis hepatis in a patient with chronic renal failure and renal cell carcinoma. Clin J Gastroenterol 2019; 13:403-407. [PMID: 31713159 DOI: 10.1007/s12328-019-01068-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/01/2019] [Indexed: 11/27/2022]
Abstract
Peliosis hepatis (PH) is a rare disease characterized by the presence of sinusoidal dilation and blood-filled cysts throughout the hepatic parenchyma. We report a case of PH in a 49-year-old woman with chronic renal failure (CRF) on hemodialysis and with renal cell carcinoma (RCC). Dynamic contrast-enhanced computed tomography (CT) showed a 35-mm-diameter, hypervascular tumor in the liver and RCC in the right renal cyst. Ultrasound and superparamagnetic iron oxide-enhanced magnetic resonance imaging were also performed; however, the liver tumor could not be distinguished from the metastasis of RCC. Therefore, echo-guided biopsy of the liver tumor using an 18-G Majima needle was performed. Histological evaluation of the specimen showed irregular sinusoidal dilatation and blood-filled cavities without malignant cells. She was ultimately diagnosed with PH. Subsequently, she underwent total right nephrectomy for RCC and was diagnosed with RCC stage 1 (pT1N0M0). A follow-up CT performed 4 months after nephrectomy showed no growth of PH. Although the development of PH in patients with CRF or RCC who do not undergo renal transplantation is extremely rare, it should be considered in the differential diagnosis to distinguish PH from the metastasis of RCC.
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Affiliation(s)
- Hiroki Maruyama
- Department of Internal Medicine, Niigata Prefectural Central Hospital, 205 Shinnancho, Joetsu City, 943-0192, Niigata, Japan
| | - Kazuya Takahashi
- Department of Internal Medicine, Niigata Prefectural Central Hospital, 205 Shinnancho, Joetsu City, 943-0192, Niigata, Japan.
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, 951-8510, Niigata, Japan.
| | - Natsuki Ishikawa
- Department of Internal Medicine, Niigata Prefectural Central Hospital, 205 Shinnancho, Joetsu City, 943-0192, Niigata, Japan
| | - Kazunori Hosaka
- Department of Internal Medicine, Niigata Prefectural Central Hospital, 205 Shinnancho, Joetsu City, 943-0192, Niigata, Japan
| | - Daisuke Kumaki
- Department of Internal Medicine, Niigata Prefectural Central Hospital, 205 Shinnancho, Joetsu City, 943-0192, Niigata, Japan
| | - Yukio Aruga
- Department of Internal Medicine, Niigata Prefectural Central Hospital, 205 Shinnancho, Joetsu City, 943-0192, Niigata, Japan
| | - Masashi Yamakawa
- Department of Internal Medicine, Niigata Prefectural Central Hospital, 205 Shinnancho, Joetsu City, 943-0192, Niigata, Japan
| | - Masaaki Hirano
- Department of Internal Medicine, Niigata Prefectural Central Hospital, 205 Shinnancho, Joetsu City, 943-0192, Niigata, Japan
| | - Kazuhiro Funakoshi
- Department of Internal Medicine, Niigata Prefectural Central Hospital, 205 Shinnancho, Joetsu City, 943-0192, Niigata, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, 951-8510, Niigata, Japan
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