Forgione, A.; Tovoli, F.; Ravaioli, M.; Renzulli, M.; Vasuri, F.; Piscaglia, F.; Granito, A. Contrast-Enhanced Ultrasound LI-RADS LR-5 in Hepatic Tuberculosis: Case Report and Literature Review of Imaging Features. Gastroenterol. Insights2021, 12, 1-9.
Forgione, A.; Tovoli, F.; Ravaioli, M.; Renzulli, M.; Vasuri, F.; Piscaglia, F.; Granito, A. Contrast-Enhanced Ultrasound LI-RADS LR-5 in Hepatic Tuberculosis: Case Report and Literature Review of Imaging Features. Gastroenterol. Insights 2021, 12, 1-9.
Forgione, A.; Tovoli, F.; Ravaioli, M.; Renzulli, M.; Vasuri, F.; Piscaglia, F.; Granito, A. Contrast-Enhanced Ultrasound LI-RADS LR-5 in Hepatic Tuberculosis: Case Report and Literature Review of Imaging Features. Gastroenterol. Insights2021, 12, 1-9.
Forgione, A.; Tovoli, F.; Ravaioli, M.; Renzulli, M.; Vasuri, F.; Piscaglia, F.; Granito, A. Contrast-Enhanced Ultrasound LI-RADS LR-5 in Hepatic Tuberculosis: Case Report and Literature Review of Imaging Features. Gastroenterol. Insights 2021, 12, 1-9.
Abstract
Background: The liver is involved in disseminated tuberculosis in more than 80% of the 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 still 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. While computed tomography and magnetic resonance imaging 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 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 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.
Keywords
contrast-enhanced ultrasound (CEUS); Liver Imaging Reporting and Data System (LI-RADS); differential diagnosis; hepatocellular carcinoma (HCC); tuberculosis
Subject
Medicine and Pharmacology, Immunology and Allergy
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
