Liver mass differential diagnosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{ | [[Image:Home_logo1.png|right|250px|link=http://www.wikidoc.org/index.php/Liver_mass]] | ||
{{ | {{CMG}}; {{AE}}{{MV}}; {{SH}}; {{ADG}} | ||
==Overview== | ==Overview== | ||
Liver mass must be differentiated from the diseases that cause abdominal pain, pruritus, low-grade fever, and ascities such as [[angiomyolipoma]], [[adenoma]], borderline (high-grade [[Dysplasia|dysplastic]]) [[Nodule (medicine)|nodule]], [[cholangiocarcinoma]], confluent [[fibrosis]], [[focal nodular hyperplasia]], focal fat sparing and deposit on [[liver]], [[gallbladder cancer]], hereditary hemorrhagic [[telangiectasia]], inflammatory pseudotumors, liver [[hemangioma]], [[hepatoblastoma]] in children, pyogenic [[Liver abscess|liver abscesses]], [[pancreatic cancer]], [[Stomach cancer]]. | |||
==Common Differential Diagnosis== | ==Common Differential Diagnosis== | ||
Liver mass must be differentiated from the following diseases that cause abdominal pain, pruritus, low-grade fever, and ascities such as:<ref name="pmid9562062">{{cite journal |vauthors=Choi BI, Kim TK, Han JK |title=MRI of clonorchiasis and cholangiocarcinoma |journal=J Magn Reson Imaging |volume=8 |issue=2 |pages=359–66 |year=1998 |pmid=9562062 |doi= |url=}}</ref><ref name="GuoXu2015">{{cite journal|last1=Guo|first1=Le-Hang|last2=Xu|first2=Hui-Xiong|title=Contrast-Enhanced Ultrasound in the Diagnosis of Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma: Controversy over the ASSLD Guideline|journal=BioMed Research International|volume=2015|year=2015|pages=1–5|issn=2314-6133|doi=10.1155/2015/349172}}</ref><ref name="WilsonKim2007">{{cite journal|last1=Wilson|first1=Stephanie R.|last2=Kim|first2=Tae Kyoung|last3=Jang|first3=Hyun-Jung|last4=Burns|first4=Peter N.|title=Enhancement Patterns of Focal Liver Masses: Discordance Between Contrast-Enhanced Sonography and Contrast-Enhanced CT and MRI|journal=American Journal of Roentgenology|volume=189|issue=1|year=2007|pages=W7–W12|issn=0361-803X|doi=10.2214/AJR.06.1060}}</ref><ref name="pmid8511316">{{cite journal |vauthors=Ohtomo K, Baron RL, Dodd GD, Federle MP, Miller WJ, Campbell WL, Confer SR, Weber KM |title=Confluent hepatic fibrosis in advanced cirrhosis: appearance at CT |journal=Radiology |volume=188 |issue=1 |pages=31–5 |year=1993 |pmid=8511316 |doi=10.1148/radiology.188.1.8511316 |url=}}</ref><ref name="WuSaluja2006">{{cite journal|last1=Wu|first1=Jim S.|last2=Saluja|first2=Sanjay|last3=Garcia-Tsao|first3=Guadalupe|last4=Chong|first4=Alice|last5=Henderson|first5=Katherine J.|last6=White|first6=Robert I.|title=Liver Involvement in Hereditary Hemorrhagic Telangiectasia: CT and Clinical Findings Do Not Correlate in Symptomatic Patients|journal=American Journal of Roentgenology|volume=187|issue=4|year=2006|pages=W399–W405|issn=0361-803X|doi=10.2214/AJR.05.1068}}</ref><ref name="ItaiMatsui1997">{{cite journal|last1=Itai|first1=Y|last2=Matsui|first2=O|title=Blood flow and liver imaging.|journal=Radiology|volume=202|issue=2|year=1997|pages=306–314|issn=0033-8419|doi=10.1148/radiology.202.2.9015047}}</ref><ref name="MathieuVasile1985"><nowiki>{{cite</nowiki></ref><ref name="pmid3881794">{{cite journal |vauthors=Mathieu D, Vasile N, Dibie C, Grenier P |title=Portal cavernoma: dynamic CT features and transient differences in hepatic attenuation |journal=Radiology |volume=154 |issue=3 |pages=743–8 |year=1985 |pmid=3881794 |doi=10.1148/radiology.154.3.3881794 |url=}}</ref><ref>Itai Y, Murata S, Saida Y, Minami M. Central zone and peripheral zone of the liver based on portal and hepatic arterial blood supply: imaging approach to deformity of cirrhotic liver. Jpn J Clin Radiol. 1994;39:1553–1559</ref><ref name="KimLee2011">{{cite journal|last1=Kim|first1=Tae Kyoung|last2=Lee|first2=Kyoung Ho|last3=Jang|first3=Hyun–Jung|last4=Haider|first4=Masoom A.|last5=Jacks|first5=Lindsay M.|last6=Menezes|first6=Ravi J.|last7=Park|first7=Seong Ho|last8=Yazdi|first8=Leyla|last9=Sherman|first9=Morris|last10=Khalili|first10=Korosh|title=Analysis of Gadobenate Dimeglumine–enhanced MR Findings for Characterizing Small (1–2-cm) Hepatic Nodules in Patients at High Risk for Hepatocellular Carcinoma|journal=Radiology|volume=259|issue=3|year=2011|pages=730–738|issn=0033-8419|doi=10.1148/radiol.11101549}}</ref><ref name="pmid11833870">{{cite journal |vauthors=Kim JH, Kim TK, Kim BS, Eun HW, Kim PN, Lee MG, Ha HK |title=Enhancement of hepatic hemangiomas with levovist on coded harmonic angiographic ultrasonography |journal=J Ultrasound Med |volume=21 |issue=2 |pages=141–8 |year=2002 |pmid=11833870 |doi= |url=}}</ref><ref name="BranniganBurns2004">{{cite journal|last1=Brannigan|first1=Margot|last2=Burns|first2=Peter N.|last3=Wilson|first3=Stephanie R.|title=Blood Flow Patterns in Focal Liver Lesions at Microbubble-enhanced US|journal=RadioGraphics|volume=24|issue=4|year=2004|pages=921–935|issn=0271-5333|doi=10.1148/rg.244035158}}</ref><ref name="pmid16641791">{{cite journal |vauthors=Kim TK, Jang HJ, Wilson SR |title=Benign liver masses: imaging with microbubble contrast agents |journal=Ultrasound Q |volume=22 |issue=1 |pages=31–9 |year=2006 |pmid=16641791 |doi= |url=}}</ref><ref name="JangKim2003">{{cite journal|last1=Jang|first1=Hyun-Jung|last2=Kim|first2=Tae Kyoung|last3=Lim|first3=Hyo Keun|last4=Park|first4=Sang Jae|last5=Sim|first5=Jung Suk|last6=Kim|first6=Hyae Young|last7=Lee|first7=Joo-Hyuk|title=Hepatic Hemangioma: Atypical Appearances on CT, MR Imaging, and Sonography|journal=American Journal of Roentgenology|volume=180|issue=1|year=2003|pages=135–141|issn=0361-803X|doi=10.2214/ajr.180.1.1800135}}</ref><ref>{{cite journal|doi=10.1102/1470-7330.2009.0015}}</ref><ref name="JangYu2009">{{cite journal|last1=Jang|first1=Hyun-Jung|last2=Yu|first2=Hojun|last3=Kim|first3=Tae Kyoung|title=Imaging of Focal Liver Lesions|journal=Seminars in Roentgenology|volume=44|issue=4|year=2009|pages=266–282|issn=0037198X|doi=10.1053/j.ro.2009.05.008}}</ref><ref name="JangYu2009" /><ref name="BhayanaKim2010">{{cite journal|last1=Bhayana|first1=Deepak|last2=Kim|first2=Tae Kyoung|last3=Jang|first3=Hyun-Jung|last4=Burns|first4=Peter N.|last5=Wilson|first5=Stephanie R.|title=Hypervascular Liver Masses on Contrast-Enhanced Ultrasound: The Importance of Washout|journal=American Journal of Roentgenology|volume=194|issue=4|year=2010|pages=977–983|issn=0361-803X|doi=10.2214/AJR.09.3375}}</ref><ref name="pmid21427331">{{cite journal |vauthors=Tamada T, Ito K, Yamamoto A, Sone T, Kanki A, Tanaka F, Higashi H |title=Hepatic hemangiomas: evaluation of enhancement patterns at dynamic MRI with gadoxetate disodium |journal=AJR Am J Roentgenol |volume=196 |issue=4 |pages=824–30 |year=2011 |pmid=21427331 |doi=10.2214/AJR.10.5113 |url=}}</ref><ref name="Heiken2007">{{cite journal|last1=Heiken|first1=Jay P.|title=Distinguishing benign from malignant liver tumours|journal=Cancer Imaging|volume=7|issue=Special Issue A|year=2007|pages=S1–S14|issn=1470-7330|doi=10.1102/1470-7330.2007.9084}}</ref><ref name="AlturkistanyJang2011">{{cite journal|last1=Alturkistany|first1=Samira|last2=Jang|first2=Hyun-Jung|last3=Yu|first3=Hojun|last4=Lee|first4=Kyoung Ho|last5=Kim|first5=Tae Kyoung|title=Fading hepatic hemangiomas on multiphasic CT|journal=Abdominal Radiology|volume=37|issue=5|year=2011|pages=775–780|issn=2366-004X|doi=10.1007/s00261-011-9826-6}}</ref><ref name="pmid18359914">{{cite journal |vauthors=Liu GJ, Lu MD, Xie XY, Xu HX, Xu ZF, Zheng YL, Liang JY, Wang W |title=Real-time contrast-enhanced ultrasound imaging of infected focal liver lesions |journal=J Ultrasound Med |volume=27 |issue=4 |pages=657–66 |year=2008 |pmid=18359914 |doi= |url=}}</ref><ref name="KimChoi2004">{{cite journal|last1=Kim|first1=Kyoung Won|last2=Choi|first2=Byung Ihn|last3=Park|first3=Seong Ho|last4=Kim|first4=Ah Young|last5=Koh|first5=Young Hwan|last6=Lee|first6=Hyun Ju|last7=Han|first7=Joon Koo|title=Pyogenic hepatic abscesses: distinctive features from hypovascular hepatic malignancies on contrast-enhanced ultrasound with SH U 508A; early experience|journal=Ultrasound in Medicine & Biology|volume=30|issue=6|year=2004|pages=725–733|issn=03015629|doi=10.1016/j.ultrasmedbio.2004.03.006}}</ref><ref name="pmid16641791" /><ref name="pmid17161932">{{cite journal |vauthors=Syed MA, Kim TK, Jang HJ |title=Portal and hepatic vein thrombosis in liver abscess: CT findings |journal=Eur J Radiol |volume=61 |issue=3 |pages=513–9 |year=2007 |pmid=17161932 |doi=10.1016/j.ejrad.2006.11.022 |url=}}</ref><ref name="MeniasSurabhi2008">{{cite journal|last1=Menias|first1=Christine O.|last2=Surabhi|first2=Venkateswar R.|last3=Prasad|first3=Srinivasa R.|last4=Wang|first4=Hanlin L.|last5=Narra|first5=Vamsi R.|last6=Chintapalli|first6=Kedar N.|title=Mimics of Cholangiocarcinoma: Spectrum of Disease|journal=RadioGraphics|volume=28|issue=4|year=2008|pages=1115–1129|issn=0271-5333|doi=10.1148/rg.284075148}}</ref><ref name="pmid1734701">{{cite journal |vauthors=Gollapudi P, Chejfec G, Zarling EJ |title=Spontaneous regression of hepatic pseudotumor |journal=Am. J. Gastroenterol. |volume=87 |issue=2 |pages=214–7 |year=1992 |pmid=1734701 |doi= |url=}}</ref><ref name="pmid10228516">{{cite journal |vauthors=Yoon KH, Ha HK, Lee JS, Suh JH, Kim MH, Kim PN, Lee MG, Yun KJ, Choi SC, Nah YH, Kim CG, Won JJ, Auh YH |title=Inflammatory pseudotumor of the liver in patients with recurrent pyogenic cholangitis: CT-histopathologic correlation |journal=Radiology |volume=211 |issue=2 |pages=373–9 |year=1999 |pmid=10228516 |doi=10.1148/radiology.211.2.r99ma36373 |url=}}</ref><ref name="CHEDIDKRUEL2017">{{cite journal|last1=CHEDID|first1=Marcio F.|last2=KRUEL|first2=Cleber R. P.|last3=PINTO|first3=Marcelo A.|last4=GREZZANA-FILHO|first4=Tomaz J. M.|last5=LEIPNITZ|first5=Ian|last6=KRUEL|first6=Cleber D. P.|last7=SCAFFARO|first7=Leandro A.|last8=CHEDID|first8=Aljamir D.|title=HEPATOCELLULAR CARCINOMA: DIAGNOSIS AND OPERATIVE MANAGEMENT|journal=ABCD. 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== | |||
<small>'''Abbreviations:''' '''[[RUQ]]'''= Right upper quadrant of the abdomen, '''LUQ'''= Left upper quadrant, '''LLQ'''= Left lower quadrant, '''RLQ'''= Right lower quadrant, '''LFT'''= Liver function test, SIRS= [[Systemic inflammatory response syndrome]], '''[[ERCP]]'''= [[Endoscopic retrograde cholangiopancreatography]], '''IV'''= Intravenous, '''N'''= Normal, '''AMA'''= Anti mitochondrial antibodies, '''[[LDH]]'''= [[Lactate dehydrogenase]], '''GI'''= Gastrointestinal, '''CXR'''= Chest X ray, '''IgA'''= [[Immunoglobulin A]], '''IgG'''= [[Immunoglobulin G]], '''IgM'''= [[Immunoglobulin M]], '''CT'''= [[Computed tomography]], '''[[PMN]]'''= Polymorphonuclear cells, '''[[ESR]]'''= [[Erythrocyte sedimentation rate]], '''[[CRP]]'''= [[C-reactive protein]], TS= [[Transferrin saturation]], SF= Serum [[Ferritin]], SMA= [[Superior mesenteric artery]], SMV= [[Superior mesenteric vein]], ECG= [[Electrocardiogram]] | |||
{| class="wikitable" style="border: 0px; font-size: 90%; margin: 5px;" align="center" | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" rowspan="3" |Disease | |||
| style="background:#4479BA; color: #FFFFFF;" colspan="13" align="center" rowspan="1" |'''Clinical manifestations''' | |||
! style="background:#4479BA; color: #FFFFFF;" colspan="2" align="center" rowspan="2" |Diagnosis | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" rowspan="3" |Comments | |||
|- | |||
| style="background:#4479BA; color: #FFFFFF;" colspan="9" align="center" rowspan="1" |'''Symptoms''' | |||
! style="background:#4479BA; color: #FFFFFF;" colspan="4" align="center" rowspan="1" | Signs | |||
|- | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal Pain | |||
! style="background:#4479BA; color: #FFFFFF;" colspan="1" align="center" rowspan="1" | Fever | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rigors and chills | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Nausea or vomiting | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Jaundice | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Constipation | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |GI bleeding | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Hypo- | |||
tension | |||
! style="background:#4479BA; color: #FFFFFF;" colspan="1" align="center" rowspan="1" | Guarding | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rebound Tenderness | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Bowel sounds | |||
! style="background:#4479BA; color: #FFFFFF;" colspan="1" align="center" rowspan="1" | Lab Findings | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''[[Hepatocellular carcinoma]]/[[Metastasis]]''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Normal | |||
* Hyperactive if obstruction present | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* High levels of [[Alpha-fetoprotein|AFP]] in serum | |||
* Abnormal [[Liver function test|liver function tests]] | |||
*[[Thrombocytopenia]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Ultrasound|US]] | |||
* [[Computed tomography|CT]] | |||
* [[MRI]] | |||
* [[Liver biopsy]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
Other symptoms: | |||
* [[Splenomegaly]] | |||
* [[Variceal bleeding]] | |||
* [[Ascites]] | |||
* [[Spider nevi]] | |||
* [[Asterixis]] | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" colspan="1" align="center" rowspan="1" |[[Cholangiocarcinoma]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Elevated [[CA-19-9|CA 19-9]] | |||
* Increased [[amylase]] / [[lipase]] | |||
* Increased [[Steatorrhea|stool fat]] content | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
*[[Contrast-enhanced ultrasound]] | |||
*[[Computed tomography|CT scan]] | |||
**[[Calcification]] | |||
**[[Pseudocyst]] | |||
**Dilation of main pancreatic duct | |||
*[[Magnetic resonance imaging|MRI]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Predisposes to pancreatic cancer | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pancreatic carcinoma]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Mid[[Epigastric]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Normal | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* ↑ [[Alkaline phosphatase]] | |||
* ↑ [[Bilirubin|serum bilirubin]] | |||
* ↑ [[gamma-glutamyl transpeptidase]] | |||
* ↑ [[CA-19-9|CA 19-9]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Computed tomography|MDCT]] with [[Positron emission tomography|PET]]/[[Computed tomography|CT]] | |||
* MRI | |||
* [[Endoscopic ultrasound|EUS]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
[[Skin]] manifestations may include: | |||
* [[Bullous pemphigoid]] | |||
* [[Mucous membrane pemphigoid|Cicatricial pemphigoid]] | |||
* [[Thrombophlebitis|Migratory superficial thrombophlebitis]] (classic [[Trousseau's syndrome]]) | |||
* [[Panniculitis|Pancreatic panniculitis]] | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Focal nodular hyperplasia]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Normal Liver function tests | |||
* Normal AFP | |||
*Minor elevations of | |||
**[[Aspartate]] | |||
**[[Alanine aminotransferase]] | |||
**[[Alkaline phosphatase]] | |||
**[[Gamma glutamyl transpeptidase]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Us | |||
* Multiphasic [[helical CT scan]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Open [[biopsy]] if diagnosis can not be established | |||
|- | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Disease | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal Pain | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Fever | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rigors and chills | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Nausea or vomiting | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Jaundice | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Constipation | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Diarrhea | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Weight loss | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |GI bleeding | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Hypo- | |||
tension | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Guarding | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rebound Tenderness | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Bowel sounds | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Lab Findings | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging | |||
! style="background:#4479BA; color: #FFFFFF;" align="center" |Comments | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gallbladder cancer]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Mid[[Epigastric|epigastric]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | Normal | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* ↑ [[Alkaline phosphatase]] | |||
* ↑ [[CA-19-9|CA 19-9]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Ultrasonography|US]] | |||
* CT | |||
* MRI | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Liver hemangioma]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Intermittent [[RUQ]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>−</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Abnormal LFTs | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* US | |||
* [[Single photon emission computed tomography|Single-photon emission computerized tomography(SPECT]]) | |||
* MRI | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* US will reveal hypoechoic [[lesions]] | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Liver abscess]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |RUQ | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Hypoalbuminemia | |||
* Abnormal [[Liver function test|liver function tests]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* US | |||
* CT | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cirrhosis|Cirrhosis]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]+Bloating | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Hypoalbuminemia]] | |||
* Prolonged PT | |||
* Abnormal LFTs | |||
* [[Hyponatremia]] | |||
* [[Thrombocytopenia]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |US | |||
* Nodular, shrunken liver | |||
* [[Ascites]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Stigmata of liver disease | |||
* Cruveilhier- Baumgarten murmur | |||
|- style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Inflammatory lesions | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ± | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>−</nowiki> | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | − | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* [[Hypoalbuminemia]] | |||
* Prolonged PT | |||
* Abnormal LFTs | |||
* [[Hyponatremia]] | |||
* [[Thrombocytopenia]] | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |US | |||
* Nodular,shrunken or coarse liver | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | | |||
* Stigmata of liver disease | |||
|- | |||
|}<small> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Medicine]] | |||
[[Category:Gastroenterology]] | |||
[[Category:Hepatology]] | |||
[[Category:Oncology]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Surgery]] | |||
Latest revision as of 22:31, 29 July 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]; Dildar Hussain, MBBS [3]; Aditya Ganti M.B.B.S. [4]
Overview
Liver mass must be differentiated from the diseases that cause abdominal pain, pruritus, low-grade fever, and ascities such as angiomyolipoma, adenoma, borderline (high-grade dysplastic) nodule, cholangiocarcinoma, confluent fibrosis, focal nodular hyperplasia, focal fat sparing and deposit on liver, gallbladder cancer, hereditary hemorrhagic telangiectasia, inflammatory pseudotumors, liver hemangioma, hepatoblastoma in children, pyogenic liver abscesses, pancreatic cancer, Stomach cancer.
Common Differential Diagnosis
Liver mass must be differentiated from the following diseases that cause abdominal pain, pruritus, low-grade fever, and ascities such as:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][16][17][18][19][20][21][22][13][23][24][25][26][27]
Abbreviations: RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum Ferritin, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram
| Disease | Clinical manifestations | Diagnosis | Comments | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Symptoms | Signs | |||||||||||||||
| Abdominal Pain | Fever | Rigors and chills | Nausea or vomiting | Jaundice | Constipation | Diarrhea | Weight loss | GI bleeding | Hypo-
tension |
Guarding | Rebound Tenderness | Bowel sounds | Lab Findings | Imaging | ||
| Hepatocellular carcinoma/Metastasis | RUQ | + | − | + | + | + | + | + | + | + | − | + |
|
|
Other symptoms: | |
| Cholangiocarcinoma | RUQ | + | − | + | + | − | − | + | − | − | − | + | Normal |
|
| |
| Pancreatic carcinoma | MidEpigastric | − | − | + | + | + | − | + | − | − | − | + | Normal |
Skin manifestations may include: | ||
| Focal nodular hyperplasia | Diffuse | ± | − | − | ± | − | − | + | + | − | − | − | Normal |
|
|
|
| Disease | Abdominal Pain | Fever | Rigors and chills | Nausea or vomiting | Jaundice | Constipation | Diarrhea | Weight loss | GI bleeding | Hypo-
tension |
Guarding | Rebound Tenderness | Bowel sounds | Lab Findings | Imaging | Comments |
| Gallbladder cancer | Midepigastric | − | − | + | + | − | + | + | − | − | − | − | Normal |
|
||
| Liver hemangioma | Intermittent RUQ | − | − | + | + | − | − | − | − | − | − | − | Normal |
|
| |
| Liver abscess | RUQ | + | − | + | + | − | − | + | − | − | − | − | Normal |
|
|
|
| Cirrhosis | RUQ+Bloating | + | − | + | + | − | − | + | − | − | − | − | Normal |
|
US
|
|
| Inflammatory lesions | RUQ | ± | − | + | + | − | − | − | − | − | − | − | Normal |
|
US
|
|
References
- ↑ Choi BI, Kim TK, Han JK (1998). "MRI of clonorchiasis and cholangiocarcinoma". J Magn Reson Imaging. 8 (2): 359–66. PMID 9562062.
- ↑ Guo, Le-Hang; Xu, Hui-Xiong (2015). "Contrast-Enhanced Ultrasound in the Diagnosis of Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma: Controversy over the ASSLD Guideline". BioMed Research International. 2015: 1–5. doi:10.1155/2015/349172. ISSN 2314-6133.
- ↑ Wilson, Stephanie R.; Kim, Tae Kyoung; Jang, Hyun-Jung; Burns, Peter N. (2007). "Enhancement Patterns of Focal Liver Masses: Discordance Between Contrast-Enhanced Sonography and Contrast-Enhanced CT and MRI". American Journal of Roentgenology. 189 (1): W7–W12. doi:10.2214/AJR.06.1060. ISSN 0361-803X.
- ↑ Ohtomo K, Baron RL, Dodd GD, Federle MP, Miller WJ, Campbell WL, Confer SR, Weber KM (1993). "Confluent hepatic fibrosis in advanced cirrhosis: appearance at CT". Radiology. 188 (1): 31–5. doi:10.1148/radiology.188.1.8511316. PMID 8511316.
- ↑ Wu, Jim S.; Saluja, Sanjay; Garcia-Tsao, Guadalupe; Chong, Alice; Henderson, Katherine J.; White, Robert I. (2006). "Liver Involvement in Hereditary Hemorrhagic Telangiectasia: CT and Clinical Findings Do Not Correlate in Symptomatic Patients". American Journal of Roentgenology. 187 (4): W399–W405. doi:10.2214/AJR.05.1068. ISSN 0361-803X.
- ↑ Itai, Y; Matsui, O (1997). "Blood flow and liver imaging". Radiology. 202 (2): 306–314. doi:10.1148/radiology.202.2.9015047. ISSN 0033-8419.
- ↑ {{cite
- ↑ Mathieu D, Vasile N, Dibie C, Grenier P (1985). "Portal cavernoma: dynamic CT features and transient differences in hepatic attenuation". Radiology. 154 (3): 743–8. doi:10.1148/radiology.154.3.3881794. PMID 3881794.
- ↑ Itai Y, Murata S, Saida Y, Minami M. Central zone and peripheral zone of the liver based on portal and hepatic arterial blood supply: imaging approach to deformity of cirrhotic liver. Jpn J Clin Radiol. 1994;39:1553–1559
- ↑ Kim, Tae Kyoung; Lee, Kyoung Ho; Jang, Hyun–Jung; Haider, Masoom A.; Jacks, Lindsay M.; Menezes, Ravi J.; Park, Seong Ho; Yazdi, Leyla; Sherman, Morris; Khalili, Korosh (2011). "Analysis of Gadobenate Dimeglumine–enhanced MR Findings for Characterizing Small (1–2-cm) Hepatic Nodules in Patients at High Risk for Hepatocellular Carcinoma". Radiology. 259 (3): 730–738. doi:10.1148/radiol.11101549. ISSN 0033-8419.
- ↑ Kim JH, Kim TK, Kim BS, Eun HW, Kim PN, Lee MG, Ha HK (2002). "Enhancement of hepatic hemangiomas with levovist on coded harmonic angiographic ultrasonography". J Ultrasound Med. 21 (2): 141–8. PMID 11833870.
- ↑ Brannigan, Margot; Burns, Peter N.; Wilson, Stephanie R. (2004). "Blood Flow Patterns in Focal Liver Lesions at Microbubble-enhanced US". RadioGraphics. 24 (4): 921–935. doi:10.1148/rg.244035158. ISSN 0271-5333.
- ↑ 13.0 13.1 Kim TK, Jang HJ, Wilson SR (2006). "Benign liver masses: imaging with microbubble contrast agents". Ultrasound Q. 22 (1): 31–9. PMID 16641791.
- ↑ Jang, Hyun-Jung; Kim, Tae Kyoung; Lim, Hyo Keun; Park, Sang Jae; Sim, Jung Suk; Kim, Hyae Young; Lee, Joo-Hyuk (2003). "Hepatic Hemangioma: Atypical Appearances on CT, MR Imaging, and Sonography". American Journal of Roentgenology. 180 (1): 135–141. doi:10.2214/ajr.180.1.1800135. ISSN 0361-803X.
- ↑ . doi:10.1102/1470-7330.2009.0015. Missing or empty
|title=(help) - ↑ 16.0 16.1 Jang, Hyun-Jung; Yu, Hojun; Kim, Tae Kyoung (2009). "Imaging of Focal Liver Lesions". Seminars in Roentgenology. 44 (4): 266–282. doi:10.1053/j.ro.2009.05.008. ISSN 0037-198X.
- ↑ Bhayana, Deepak; Kim, Tae Kyoung; Jang, Hyun-Jung; Burns, Peter N.; Wilson, Stephanie R. (2010). "Hypervascular Liver Masses on Contrast-Enhanced Ultrasound: The Importance of Washout". American Journal of Roentgenology. 194 (4): 977–983. doi:10.2214/AJR.09.3375. ISSN 0361-803X.
- ↑ Tamada T, Ito K, Yamamoto A, Sone T, Kanki A, Tanaka F, Higashi H (2011). "Hepatic hemangiomas: evaluation of enhancement patterns at dynamic MRI with gadoxetate disodium". AJR Am J Roentgenol. 196 (4): 824–30. doi:10.2214/AJR.10.5113. PMID 21427331.
- ↑ Heiken, Jay P. (2007). "Distinguishing benign from malignant liver tumours". Cancer Imaging. 7 (Special Issue A): S1–S14. doi:10.1102/1470-7330.2007.9084. ISSN 1470-7330.
- ↑ Alturkistany, Samira; Jang, Hyun-Jung; Yu, Hojun; Lee, Kyoung Ho; Kim, Tae Kyoung (2011). "Fading hepatic hemangiomas on multiphasic CT". Abdominal Radiology. 37 (5): 775–780. doi:10.1007/s00261-011-9826-6. ISSN 2366-004X.
- ↑ Liu GJ, Lu MD, Xie XY, Xu HX, Xu ZF, Zheng YL, Liang JY, Wang W (2008). "Real-time contrast-enhanced ultrasound imaging of infected focal liver lesions". J Ultrasound Med. 27 (4): 657–66. PMID 18359914.
- ↑ Kim, Kyoung Won; Choi, Byung Ihn; Park, Seong Ho; Kim, Ah Young; Koh, Young Hwan; Lee, Hyun Ju; Han, Joon Koo (2004). "Pyogenic hepatic abscesses: distinctive features from hypovascular hepatic malignancies on contrast-enhanced ultrasound with SH U 508A; early experience". Ultrasound in Medicine & Biology. 30 (6): 725–733. doi:10.1016/j.ultrasmedbio.2004.03.006. ISSN 0301-5629.
- ↑ Syed MA, Kim TK, Jang HJ (2007). "Portal and hepatic vein thrombosis in liver abscess: CT findings". Eur J Radiol. 61 (3): 513–9. doi:10.1016/j.ejrad.2006.11.022. PMID 17161932.
- ↑ Menias, Christine O.; Surabhi, Venkateswar R.; Prasad, Srinivasa R.; Wang, Hanlin L.; Narra, Vamsi R.; Chintapalli, Kedar N. (2008). "Mimics of Cholangiocarcinoma: Spectrum of Disease". RadioGraphics. 28 (4): 1115–1129. doi:10.1148/rg.284075148. ISSN 0271-5333.
- ↑ Gollapudi P, Chejfec G, Zarling EJ (1992). "Spontaneous regression of hepatic pseudotumor". Am. J. Gastroenterol. 87 (2): 214–7. PMID 1734701.
- ↑ Yoon KH, Ha HK, Lee JS, Suh JH, Kim MH, Kim PN, Lee MG, Yun KJ, Choi SC, Nah YH, Kim CG, Won JJ, Auh YH (1999). "Inflammatory pseudotumor of the liver in patients with recurrent pyogenic cholangitis: CT-histopathologic correlation". Radiology. 211 (2): 373–9. doi:10.1148/radiology.211.2.r99ma36373. PMID 10228516.
- ↑ CHEDID, Marcio F.; KRUEL, Cleber R. P.; PINTO, Marcelo A.; GREZZANA-FILHO, Tomaz J. M.; LEIPNITZ, Ian; KRUEL, Cleber D. P.; SCAFFARO, Leandro A.; CHEDID, Aljamir D. (2017). "HEPATOCELLULAR CARCINOMA: DIAGNOSIS AND OPERATIVE MANAGEMENT". ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo). 30 (4): 272–278. doi:10.1590/0102-6720201700040011. ISSN 2317-6326.