Figure 1
Noncontrast MDCT
CT without contrast in the right lobe of the liver revealed patchy formation of high density.
Tuberculoma of the liver
SectionAbdominal imaging
Case TypeClinical Cases
AuthorsDorovskikh Galina, Kozhedub Sergey
Connected authors
64 years, female
Clinical History
64-year-old female patient.
Complaint: pain in the right upper quadrant, weight loss.
Anamnesis: In 1980, the patient underwent amputation of the right kidney because of tuberculosis. The patient underwent an intensive course of TB treatment for several years.
Liver function tests showed moderately elevated values.
Complaint: pain in the right upper quadrant, weight loss.
Anamnesis: In 1980, the patient underwent amputation of the right kidney because of tuberculosis. The patient underwent an intensive course of TB treatment for several years.
Liver function tests showed moderately elevated values.
Imaging Findings
MDCT of abdomen with injection of contrast agent was performed (OMNIPAQUE 100 ml, speed of injection 4.5 ml/sec).
CT without contrast in the right lobe of the liver revealed patchy formation of high density.
The density characteristics of the formation in the liver have not changed throughout all phases of contrast enhancement.
Hints of active tuberculosis have not been received, but there were signs of adhesions and bowel perforation in the liver, aerobilia.
CT without contrast in the right lobe of the liver revealed patchy formation of high density.
The density characteristics of the formation in the liver have not changed throughout all phases of contrast enhancement.
Hints of active tuberculosis have not been received, but there were signs of adhesions and bowel perforation in the liver, aerobilia.
Discussion
Tuberculoma of the liver is an isolated liver tumour. Hepatic tuberculosis is usually associated with active pulmonary or miliary tuberculosis, but rarely looks like a liver tumour mass. A deeper awareness of this rare clinical entity may prevent needless surgical intervention. [1]
This patient had consulted surgeons. Tuberculosis was first diagnosed in 1980. After the removal of a part of the intestine and right kidney their morphology was diagnosed as tuberculosis. Liver damage was also diagnosed in 1980. The patient underwent several courses of chemotherapy; as a result, active TB was excluded. Resection of the right lobe of the liver and intestine were done; tuberculosis and cholangitis were diagnosed morphologically.
Conclusion: MDCT with the contrast enhancement is a highly effective method of identification of tumour vascularization. Lack of vascularization of the tumour in this case allows excluding hepatocellular carcinoma, and the presence of large amounts of calcium indicates possible tuberculosis.
This patient had consulted surgeons. Tuberculosis was first diagnosed in 1980. After the removal of a part of the intestine and right kidney their morphology was diagnosed as tuberculosis. Liver damage was also diagnosed in 1980. The patient underwent several courses of chemotherapy; as a result, active TB was excluded. Resection of the right lobe of the liver and intestine were done; tuberculosis and cholangitis were diagnosed morphologically.
Conclusion: MDCT with the contrast enhancement is a highly effective method of identification of tumour vascularization. Lack of vascularization of the tumour in this case allows excluding hepatocellular carcinoma, and the presence of large amounts of calcium indicates possible tuberculosis.
Differential Diagnosis List
Tuberculoma right lobe of the liver
Hepatocellular carcinoma
Echinococcus
Final Diagnosis
Tuberculoma right lobe of the liver
References
[1] W-T Huang, C-C Wang, W-j Chen, Y-F Cheng, and H-L Eng (2003) The nodular form of hepatic tuberculosis: a review with five additional new cases. J Clin Pathol 56:835–839 (PMID: 14600128)
Case information
| URL: | https://www.eurorad.org/case/11362 |
| DOI: | 10.1594/EURORAD/CASE.11362 |
| ISSN: | 1563-4086 |
Figure 4
Volume postcontrast images (multiphase)
After infusion of contrast formation does not accumulate contrast in any of the phases of contrast
Noncontrast MDCT
CT without contrast in the right lobe of the liver revealed patchy formation of high density.
Patient P., Radiology dept., City emergency hospital, Omsk, Russion Federation
Patient P., Radiology dept., City emergency hospital, Omsk, Russion Federation
Axial postcontrast images (multiphase)
After infusion of contrast formation does not accumulate contrast in any of the phases of contrast.
Patient P., Radiology dept., City emergency hospital, Omsk, Russion Federation
Patient P., Radiology dept., City emergency hospital, Omsk, Russion Federation
After infusion of contrast formation does not accumulate contrast in any of the phases of contrast.
Patient P., Radiology dept., City emergency hospital, Omsk, Russion Federation
Patient P., Radiology dept., City emergency hospital, Omsk, Russion Federation
Coronal, sagittal postcontrast images (multiphase)
After infusion of contrast formation does not accumulate contrast in any of the phases of contrast
Patient P., Radiology dept., City emergency hospital, Omsk, Russion Federation
Patient P., Radiology dept., City emergency hospital, Omsk, Russion Federation
After infusion of contrast formation does not accumulate contrast in any of the phases of contrast
Patient P., Radiology dept., City emergency hospital, Omsk, Russion Federation
Patient P., Radiology dept., City emergency hospital, Omsk, Russion Federation
Volume postcontrast images (multiphase)
After infusion of contrast formation does not accumulate contrast in any of the phases of contrast
Patient P., Radiology dept., City emergency hospital, Omsk, Russion Federation
Patient P., Radiology dept., City emergency hospital, Omsk, Russion Federation