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Peliosis hepatis differential diagnosis

Introduction

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Overview

Overview

Peliosis hepatis must be differentiated from Hepatic Adenoma, Hemangioma, Focal Nodular Hyperplasia, Hepatic Abscess, Hypervascular Metastases, and Hepatocellular Carcinoma.[1] Polycystic liver disease, Congenital hepatic fibrosis, Solitary congenital cysts, Hydatid cyst, Von Meyenburg complexes, Caroli disease (type V choledochal cyst).[2]

Differential Diagnosis

Differential Diagnosis

Peliosis hepatis must be differentiated from Hepatic Adenoma Hemangioma Focal Nodular Hyperplasia Hepatic Abscess Hypervascular Metastases Hepatocellular Carcinoma.[3] Polycystic liver disease, Congenital hepatic fibrosis, Solitary congenital cysts, Hydatid cyst, Von Meyenburg complexes, Caroli disease (type V choledochal cyst).[4] 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>[5][6][7][8][9][10][11][12][13][14][15][16] [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]

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 Hypotension Guarding Rebound Tenderness Bowel Sounds Lab Findings Imaging
Hepatocellular adenoma RUQ – – – – – – – + + – –
  • Normal
Hepatocellular carcinoma/Metastasis RUQ + βˆ’ + + + + + + + βˆ’ +

Other symptoms:

Cholangiocarcinoma RUQ + βˆ’ + + βˆ’ βˆ’ + βˆ’ βˆ’ βˆ’ +
  • Normal
Pancreatic carcinoma MidEpigastric βˆ’ βˆ’ + + + βˆ’ + βˆ’ βˆ’ βˆ’ +
  • Normal

Skin manifestations may include:

Focal nodular hyperplasia Diffuse Β± βˆ’ βˆ’ Β± βˆ’ βˆ’ + + βˆ’ βˆ’ βˆ’
  • Normal
Disease Abdominal Pain Fever Rigors and Chills Nausea or Vomiting Jaundice Constipation Diarrhea Weight Loss GI Bleeding Hypotension Guarding Rebound Tenderness Bowel Sounds Lab Findings Imaging Comments
Gallbladder cancer Midepigastric βˆ’ βˆ’ + + βˆ’ + + βˆ’ βˆ’ βˆ’ βˆ’
  • Normal
Liver hemangioma Intermittent RUQ βˆ’ βˆ’ + + βˆ’ βˆ’ βˆ’ βˆ’ βˆ’ βˆ’ βˆ’
  • Normal
Liver abscess RUQ + βˆ’ + + βˆ’ βˆ’ + βˆ’ βˆ’ βˆ’ βˆ’
  • Normal
Cirrhosis RUQ +Bloating + βˆ’ + + βˆ’ βˆ’ + βˆ’ βˆ’ βˆ’ βˆ’
  • Normal
Inflammatory lesions RUQ Β± βˆ’ + + βˆ’ βˆ’ βˆ’ βˆ’ βˆ’ βˆ’ βˆ’
  • Normal
  • Stigmata of liver disease
References

References

  1. ↑ https://www.ajronline.org/doi/10.2214/AJR.05.0167#:~:text=The%20cause%20of%20peliosis%20hepatis,chronic%20wasting%20diseases%20(e.g.%2C%20tuberculosis
  2. ↑ https://www.ncbi.nlm.nih.gov/books/NBK554470/
  3. ↑ https://www.ajronline.org/doi/10.2214/AJR.05.0167#:~:text=The%20cause%20of%20peliosis%20hepatis,chronic%20wasting%20diseases%20(e.g.%2C%20tuberculosis
  4. ↑ https://www.ncbi.nlm.nih.gov/books/NBK554470/
  5. ↑ 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. PMIDΒ 21427331.
  6. ↑ 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. ISSNΒ 1470-7330.
  7. ↑ 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. ISSNΒ 2366-004X.
  8. ↑ 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. PMIDΒ 18359914.
  9. ↑ 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. ISSNΒ 0301-5629.
  10. ↑ Invalid <ref> tag; no text was provided for refs named pmid16641791
  11. ↑ 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. PMIDΒ 17161932.
  12. ↑ 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. ISSNΒ 0271-5333.
  13. ↑ Gollapudi P, Chejfec G, Zarling EJ (1992). “Spontaneous regression of hepatic pseudotumor”. Am. J. Gastroenterol. 87 (2): 214–7. PMIDΒ 1734701.
  14. ↑ 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. PMIDΒ 10228516.
  15. ↑ 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 (SΓ£o Paulo). 30 (4): 272–278. doi:10.1590/0102-6720201700040011. ISSNΒ 2317-6326.
  16. ↑ Luigi Grazioli, Lucio Olivetti, Giancarlo Mazza & Maria Pia Bondioni (2013). “MR Imaging of Hepatocellular Adenomas and Differential Diagnosis Dilemma”. International journal of hepatology. 2013: 374170. doi:10.1155/2013/374170. PMIDΒ 23606972.
  17. ↑ Lucas Maillette de Buy Wenniger, Valeska Terpstra & Ulrich Beuers (2010). “Focal nodular hyperplasia and hepatic adenoma: epidemiology and pathology”. Digestive surgery. 27 (1): 24–31. doi:10.1159/000268404. PMIDΒ 20357448.
  18. ↑ Christian Grieser, Ingo G. Steffen, Daniel Seehofer, Incken-Birthe Kramme, Robert Uktolseya, Christian Scheurig-Muenkler, Bernd Hamm & Timm Denecke (2013). “Histopathologically confirmed focal nodular hyperplasia of the liver: gadoxetic acid-enhanced MRI characteristics”. Magnetic resonance imaging. 31 (5): 755–760. doi:10.1016/j.mri.2012.11.006. PMIDΒ 23219272. Unknown parameter |month= ignored (help)
  19. ↑ Shahid M. Hussain, Turkan Terkivatan, Pieter E. Zondervan, Esmee Lanjouw, Sjoerd de Rave, Jan N. M. Ijzermans & Rob A. de Man (2004). “Focal nodular hyperplasia: findings at state-of-the-art MR imaging, US, CT, and pathologic analysis”. RadiographicsΒ : a review publication of the Radiological Society of North America, Inc. 24 (1): 3–17. doi:10.1148/rg.241035050. PMIDΒ 14730031. Unknown parameter |month= ignored (help)
  20. ↑ J. T. Ames, M. P. Federle & K. Chopra (2009). “Distinguishing clinical and imaging features of nodular regenerative hyperplasia and large regenerative nodules of the liver”. Clinical radiology. 64 (12): 1190–1195. doi:10.1016/j.crad.2009.07.015. PMIDΒ 19913129. Unknown parameter |month= ignored (help)
  21. ↑ Giovanni Morana, Luigi Grazioli, Miles A. Kirchin, Maria Pia Bondioni, Niccolo Faccioli, Alessandro Guarise & Gunther Schneider (2011). “Solid hypervascular liver lesions: accurate identification of true benign lesions on enhanced dynamic and hepatobiliary phase magnetic resonance imaging after gadobenate dimeglumine administration”. Investigative radiology. 46 (4): 225–239. doi:10.1097/RLI.0b013e3181feee3a. PMIDΒ 21102346. Unknown parameter |month= ignored (help)
  22. ↑ I. R. Wanless (1990). “Micronodular transformation (nodular regenerative hyperplasia) of the liver: a report of 64 cases among 2,500 autopsies and a new classification of benign hepatocellular nodules”. Hepatology (Baltimore, Md.). 11 (5): 787–797. PMIDΒ 2189821. Unknown parameter |month= ignored (help)
  23. ↑ I. R. Wanless (1996). “Nodular regenerative hyperplasia, dysplasia, and hepatocellular carcinoma”. The American journal of gastroenterology. 91 (5): 836–837. PMIDΒ 8633567. Unknown parameter |month= ignored (help)
  24. ↑ T. Ichikawa, M. P. Federle, L. Grazioli, J. Madariaga, M. Nalesnik & W. Marsh (1999). “Fibrolamellar hepatocellular carcinoma: imaging and pathologic findings in 31 recent cases”. Radiology. 213 (2): 352–361. doi:10.1148/radiology.213.2.r99nv31352. PMIDΒ 10551212. Unknown parameter |month= ignored (help)
  25. ↑ Jose Traila Campos, Claude B. Sirlin & Jin-Young Choi (2012). “Focal hepatic lesions in Gd-EOB-DTPA enhanced MRI: the atlas”. Insights into imaging. 3 (5): 451–474. doi:10.1007/s13244-012-0179-7. PMIDΒ 22700119. Unknown parameter |month= ignored (help)
  26. ↑ Christine Sempoux, Ghalib Jibara, Stephen C. Ward, Cathy Fan, Lihui Qin, Sasan Roayaie, M. Isabel Fiel, Myron Schwartz & Swan N. Thung (2011). “Intrahepatic cholangiocarcinoma: new insights in pathology”. Seminars in liver disease. 31 (1): 49–60. doi:10.1055/s-0031-1272839. PMIDΒ 21344350. Unknown parameter |month= ignored (help)
  27. ↑ Nathalie Guedj, Pierre Bedossa & Valerie Paradis (2010). “[Pathology of cholangiocarcinoma]”. Annales de pathologie. 30 (6): 455–463. doi:10.1016/j.annpat.2010.10.004. PMIDΒ 21167432. Unknown parameter |month= ignored (help)
  28. ↑ Y. Maetani, K. Itoh, C. Watanabe, T. Shibata, F. Ametani, H. Yamabe & J. Konishi (2001). “MR imaging of intrahepatic cholangiocarcinoma with pathologic correlation”. AJR. American journal of roentgenology. 176 (6): 1499–1507. doi:10.2214/ajr.176.6.1761499. PMIDΒ 11373220. Unknown parameter |month= ignored (help)
  29. ↑ Riccardo Manfredi, Brunella Barbaro, Gabriele Masselli, Amorino Vecchioli & Pasquale Marano (2004). “Magnetic resonance imaging of cholangiocarcinoma”. Seminars in liver disease. 24 (2): 155–164. doi:10.1055/s-2004-828892. PMIDΒ 15192788. Unknown parameter |month= ignored (help)
  30. ↑ P. Soyer, B. Van Beers, C. Grandin, J. Pringot & M. Levesque (1993). “Primary lymphoma of the liver: MR findings”. European journal of radiology. 16 (3): 209–212. PMIDΒ 8508837. Unknown parameter |month= ignored (help)
  31. ↑ E. S. Zafrani & P. Gaulard (1993). “Primary lymphoma of the liver”. Liver. 13 (2): 57–61. PMIDΒ 8510487. Unknown parameter |month= ignored (help)
  32. ↑ Saravanan Namasivayam, Diego R. Martin & Sanjay Saini (2007). “Imaging of liver metastases: MRI”. Cancer imagingΒ : the official publication of the International Cancer Imaging Society. 7: 2–9. doi:10.1102/1470-7330.2007.0002. PMIDΒ 17293303.
  33. ↑ Daichi Hayashi, Jaroslaw N. Tkacz, Stephen Hammond, Brooke C. Devenney-Cakir, Souhil Zaim, Nadia Bouzegaou, Souhila Ounadjela & Ali Guermazi (2011). “Gastroenteropancreatic neuroendocrine tumors: multimodality imaging features with pathological correlation”. Japanese journal of radiology. 29 (2): 85–91. doi:10.1007/s11604-010-0522-1. PMIDΒ 21359932. Unknown parameter |month= ignored (help)

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: