Liver mass differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Liver mass}}
[[Image:Home_logo1.png|right|250px|link=http://www.wikidoc.org/index.php/Liver_mass]]
{{CMG}}{{AE}}{{MV}}{{SH}}{{ADG}}
{{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]].
Liver mass may be differentiated according to clinical features, laboratory findings, imaging features, histological features, and genetic studies, from other diseases that cause abdominal pain, pruritus, low-grade fever, and ascities. Common differential diagnosis includes: liver abscess, simple liver cyst, and fungal infections.
==Common Differential Diagnosis==
==Common Differential Diagnosis==
Liver mass must be differentiated from the following diseases:<ref name="pmid26770920">{{cite journal |vauthors=Kim TK, Lee E, Jang HJ |title=Imaging findings of mimickers of hepatocellular carcinoma |journal=Clin Mol Hepatol |volume=21 |issue=4 |pages=326–43 |year=2015 |pmid=26770920 |pmc=4712159 |doi=10.3350/cmh.2015.21.4.326 |url=}}</ref><ref name="Ferrell2000">{{cite journal|last1=Ferrell|first1=Linda|title=Liver Pathology: Cirrhosis, Hepatitis and Primary Liver Tumors. Update and Diagnostic Problems|journal=Modern Pathology|volume=13|issue=6|year=2000|pages=679–704|issn=0893-3952|doi=10.1038/modpathol.3880119}}</ref><ref name="KimLee2015">{{cite journal|last1=Kim|first1=Tae Kyoung|last2=Lee|first2=Eunchae|last3=Jang|first3=Hyun-Jung|title=Imaging findings of mimickers of hepatocellular carcinoma|journal=Clinical and Molecular Hepatology|volume=21|issue=4|year=2015|pages=326|issn=2287-2728|doi=10.3350/cmh.2015.21.4.326}}</ref><ref name="DooLee2009">{{cite journal|last1=Doo|first1=Kyung Won|last2=Lee|first2=Chang Hee|last3=Choi|first3=Jae Woong|last4=Lee|first4=Jongmee|last5=Kim|first5=Kyeong Ah|last6=Park|first6=Cheol Min|title=“Pseudo Washout” Sign in High-Flow Hepatic Hemangioma on Gadoxetic Acid Contrast-Enhanced MRI Mimicking Hypervascular Tumor|journal=American Journal of Roentgenology|volume=193|issue=6|year=2009|pages=W490–W496|issn=0361-803X|doi=10.2214/AJR.08.1732}}</ref><ref name="pmid17510541">{{cite journal |vauthors=Zech CJ, Herrmann KA, Reiser MF, Schoenberg SO |title=MR imaging in patients with suspected liver metastases: value of liver-specific contrast agent Gd-EOB-DTPA |journal=Magn Reson Med Sci |volume=6 |issue=1 |pages=43–52 |year=2007 |pmid=17510541 |doi= |url=}}</ref><ref name="ChengTsai1995">{{cite journal|last1=Cheng|first1=H C|last2=Tsai|first2=S H|last3=Chiang|first3=J H|last4=Chang|first4=C Y|title=Hyalinized liver hemangioma mimicking malignant tumor at MR imaging.|journal=American Journal of Roentgenology|volume=165|issue=4|year=1995|pages=1016–1017|issn=0361-803X|doi=10.2214/ajr.165.4.7676959}}</ref><ref name="pmid1370873">{{cite journal |vauthors=Haratake J, Horie A, Nagafuchi Y |title=Hyalinized hemangioma of the liver |journal=Am. J. Gastroenterol. |volume=87 |issue=2 |pages=234–6 |year=1992 |pmid=1370873 |doi= |url=}}</ref><ref name="TakayasuMoriyama1986">{{cite journal|last1=Takayasu|first1=K|last2=Moriyama|first2=N|last3=Shima|first3=Y|last4=Muramatsu|first4=Y|last5=Yamada|first5=T|last6=Makuuchi|first6=M|last7=Yamasaki|first7=S|last8=Hirohashi|first8=S|title=Atypical radiographic findings in hepatic cavernous hemangioma: correlation with histologic features|journal=American Journal of Roentgenology|volume=146|issue=6|year=1986|pages=1149–1153|issn=0361-803X|doi=10.2214/ajr.146.6.1149}}</ref><ref name="pmid11039718">{{cite journal |vauthors=Yamashita Y, Shimada M, Taguchi K, Gion T, Hasegawa H, Utsunomiya T, Hamatsu T, Matsumata T, Sugimachi K |title=Hepatic sclerosing hemangioma mimicking a metastatic liver tumor: report of a case |journal=Surg. Today |volume=30 |issue=9 |pages=849–52 |year=2000 |pmid=11039718 |doi= |url=}}</ref><ref name="KimLee20152">{{cite journal|last1=Kim|first1=Tae Kyoung|last2=Lee|first2=Eunchae|last3=Jang|first3=Hyun-Jung|title=Imaging findings of mimickers of hepatocellular carcinoma|journal=Clinical and Molecular Hepatology|volume=21|issue=4|year=2015|pages=326|issn=2287-2728|doi=10.3350/cmh.2015.21.4.326}}</ref>
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. 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*[[Angiomyolipoma]]<ref name="LeeKim2012">{{cite journal|last1=Lee|first1=So Jung|last2=Kim|first2=So Yeon|last3=Kim|first3=Kyoung Won|last4=Shin|first4=Yong Moon|last5=Kim|first5=Hyoung Jung|last6=Lee|first6=Jong Seok|last7=Kim|first7=Sun A|title=Hepatic angiomyolipoma with minimal fat, mimicking hepatocellular carcinoma|journal=Clinical and Molecular Hepatology|volume=18|issue=3|year=2012|pages=330|issn=2287-2728|doi=10.3350/cmh.2012.18.3.330}}</ref><ref name="pmid25231411">{{cite journal |vauthors=Kim R, Lee JM, Joo I, Lee DH, Woo S, Han JK, Choi BI |title=Differentiation of lipid poor angiomyolipoma from hepatocellular carcinoma on gadoxetic acid-enhanced liver MR imaging |journal=Abdom Imaging |volume=40 |issue=3 |pages=531–41 |year=2015 |pmid=25231411 |doi=10.1007/s00261-014-0244-4 |url=}}</ref><ref name="pmid19200676">{{cite journal |vauthors=Jeon TY, Kim SH, Lim HK, Lee WJ |title=Assessment of triple-phase CT findings for the differentiation of fat-deficient hepatic angiomyolipoma from hepatocellular carcinoma in non-cirrhotic liver |journal=Eur J Radiol |volume=73 |issue=3 |pages=601–6 |year=2010 |pmid=19200676 |doi=10.1016/j.ejrad.2009.01.010 |url=}}</ref>
*[[Adenoma]]
*Borderline (high-grade [[Dysplasia|dysplastic]]) [[Nodule (medicine)|nodule]]
*[[Cholangiocarcinoma]]<ref name="KimChoi1997">{{cite journal|last1=Kim|first1=T K|last2=Choi|first2=B I|last3=Han|first3=J K|last4=Jang|first4=H J|last5=Cho|first5=S G|last6=Han|first6=M C|title=Peripheral cholangiocarcinoma of the liver: two-phase spiral CT findings.|journal=Radiology|volume=204|issue=2|year=1997|pages=539–543|issn=0033-8419|doi=10.1148/radiology.204.2.9240550}}</ref><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>
*Confluent [[fibrosis]]<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="HussainSyed2004">{{cite journal|last1=Hussain|first1=Hero K.|last2=Syed|first2=Ibrahim|last3=Nghiem|first3=Hanh V.|last4=Johnson|first4=Timothy D.|last5=Carlos|first5=Ruth C.|last6=Weadock|first6=William J.|last7=Francis|first7=Isaac R.|title=T2-weighted MR Imaging in the Assessment of Cirrhotic Liver|journal=Radiology|volume=230|issue=3|year=2004|pages=637–644|issn=0033-8419|doi=10.1148/radiol.2303020921}}</ref><ref name="pmid8234718">{{cite journal |vauthors=Ohtomo K, Baron RL, Dodd GD, Federle MP, Ohtomo Y, Confer SR |title=Confluent hepatic fibrosis in advanced cirrhosis: evaluation with MR imaging |journal=Radiology |volume=189 |issue=3 |pages=871–4 |year=1993 |pmid=8234718 |doi=10.1148/radiology.189.3.8234718 |url=}}</ref><ref name="pmid19380559">{{cite journal |vauthors=Brancatelli G, Baron RL, Federle MP, Sparacia G, Pealer K |title=Focal confluent fibrosis in cirrhotic liver: natural history studied with serial CT |journal=AJR Am J Roentgenol |volume=192 |issue=5 |pages=1341–7 |year=2009 |pmid=19380559 |doi=10.2214/AJR.07.2782 |url=}}</ref><ref name="pmid15050225">{{cite journal |vauthors=Kelekis NL, Makri E, Vassiou A, Patsiaoura K, Spiridakis M, Dalekos GN |title=Confluent hepatic fibrosis as the presenting imaging sign in nonadvanced alcoholic cirrhosis |journal=Clin Imaging |volume=28 |issue=2 |pages=124–7 |year=2004 |pmid=15050225 |doi=10.1016/S0899-7071(03)00243-2 |url=}}</ref><ref name="pmid9880618">{{cite journal |vauthors=Ooi CG, Chan KL, Peh WC, Saing H, Ngan H |title=Confluent hepatic fibrosis in monozygotic twins |journal=Pediatr Radiol |volume=29 |issue=1 |pages=53–5 |year=1999 |pmid=9880618 |doi=10.1007/s002470050534 |url=}}</ref><ref name="pmid23688409">{{cite journal |vauthors=Park YS, Lee CH, Kim BH, Lee J, Choi JW, Kim KA, Ahn JH, Park CM |title=Using Gd-EOB-DTPA-enhanced 3-T MRI for the differentiation of infiltrative hepatocellular carcinoma and focal confluent fibrosis in liver cirrhosis |journal=Magn Reson Imaging |volume=31 |issue=7 |pages=1137–42 |year=2013 |pmid=23688409 |doi=10.1016/j.mri.2013.01.011 |url=}}</ref>
*[[Focal nodular hyperplasia]]<ref name="pmid11906867">{{cite journal |vauthors=Brancatelli G, Federle MP, Grazioli L, Golfieri R, Lencioni R |title=Large regenerative nodules in Budd-Chiari syndrome and other vascular disorders of the liver: CT and MR imaging findings with clinicopathologic correlation |journal=AJR Am J Roentgenol |volume=178 |issue=4 |pages=877–83 |year=2002 |pmid=11906867 |doi=10.2214/ajr.178.4.1780877 |url=}}</ref><ref name="pmid12110714">{{cite journal |vauthors=Brancatelli G, Federle MP, Grazioli L, Golfieri R, Lencioni R |title=Benign regenerative nodules in Budd-Chiari syndrome and other vascular disorders of the liver: radiologic-pathologic and clinical correlation |journal=Radiographics |volume=22 |issue=4 |pages=847–62 |year=2002 |pmid=12110714 |doi=10.1148/radiographics.22.4.g02jl17847 |url=}}</ref><ref name="NewerlaSchaeffer2012">{{cite journal|last1=Newerla|first1=Caroline|last2=Schaeffer|first2=Fabienne|last3=Terracciano|first3=Luigi|last4=Hohmann|first4=Joachim|title=Multiple FNH-Like Lesions in a Patient with Chronic Budd-Chiari Syndrome: Gd-EOB-Enhanced MRI and BR1 CEUS Findings|journal=Case Reports in Radiology|volume=2012|year=2012|pages=1–5|issn=2090-6862|doi=10.1155/2012/685486}}</ref><ref name="pmid22618456">{{cite journal |vauthors=Yoneda N, Matsui O, Kitao A, Kita R, Kozaka K, Koda W, Kobayashi S, Gabata T, Ikeda H, Sato Y, Nakanuma Y |title=Hepatocyte transporter expression in FNH and FNH-like nodule: correlation with signal intensity on gadoxetic acid enhanced magnetic resonance images |journal=Jpn J Radiol |volume=30 |issue=6 |pages=499–508 |year=2012 |pmid=22618456 |doi=10.1007/s11604-012-0085-4 |url=}}</ref>
*Focal fat sparing and deposit on liver<ref name="MatsuiKadoya1995">{{cite journal|last1=Matsui|first1=O|last2=Kadoya|first2=M|last3=Takahashi|first3=S|last4=Yoshikawa|first4=J|last5=Gabata|first5=T|last6=Takashima|first6=T|last7=Kitagawa|first7=K|title=Focal sparing of segment IV in fatty livers shown by sonography and CT: correlation with aberrant gastric venous drainage.|journal=American Journal of Roentgenology|volume=164|issue=5|year=1995|pages=1137–1140|issn=0361-803X|doi=10.2214/ajr.164.5.7717220}}</ref><ref name="pmid10101644">{{cite journal |vauthors=Itai Y, Matsui O |title='Nonportal' splanchnic venous supply to the liver: abnormal findings on CT, US and MRI |journal=Eur Radiol |volume=9 |issue=2 |pages=237–43 |year=1999 |pmid=10101644 |doi=10.1007/s003300050661 |url=}}</ref><ref name="NicolauBr�2004">{{cite journal|last1=Nicolau|first1=C.|last2=Br�|first2=C.|title=Focal liver lesions: evaluation with contrast-enhanced ultrasonography|journal=Abdominal Imaging|volume=29|issue=3|year=2004|issn=0942-8925|doi=10.1007/s00261-003-0117-8}}</ref><ref name="pmid17102041">{{cite journal |vauthors=Hamer OW, Aguirre DA, Casola G, Lavine JE, Woenckhaus M, Sirlin CB |title=Fatty liver: imaging patterns and pitfalls |journal=Radiographics |volume=26 |issue=6 |pages=1637–53 |year=2006 |pmid=17102041 |doi=10.1148/rg.266065004 |url=}}</ref><ref name="pmid16100085">{{cite journal |vauthors=Hamer OW, Aguirre DA, Casola G, Sirlin CB |title=Imaging features of perivascular fatty infiltration of the liver: initial observations |journal=Radiology |volume=237 |issue=1 |pages=159–69 |year=2005 |pmid=16100085 |doi=10.1148/radiol.2371041580 |url=}}</ref>
*[[Gallbladder cancer]]
*[[Hereditary hemorrhagic telangiectasia]]<ref name="MemeoStabile Ianora2004">{{cite journal|last1=Memeo|first1=M.|last2=Stabile Ianora|first2=A. A.|last3=Scardapane|first3=A.|last4=Buonamico|first4=P.|last5=Sabbà|first5=C.|last6=Angelelli|first6=G.|title=Hepatic involvement in hereditary hemorrhagic telangiectasia:|journal=Abdominal Imaging|volume=29|issue=2|year=2004|pages=211–220|issn=0942-8925|doi=10.1007/s00261-003-0101-3}}</ref><ref name="pmid18203937">{{cite journal |vauthors=Siddiki H, Doherty MG, Fletcher JG, Stanson AW, Vrtiska TJ, Hough DM, Fidler JL, McCollough CH, Swanson KL |title=Abdominal findings in hereditary hemorrhagic telangiectasia: pictorial essay on 2D and 3D findings with isotropic multiphase CT |journal=Radiographics |volume=28 |issue=1 |pages=171–84 |year=2008 |pmid=18203937 |doi=10.1148/rg.281075037 |url=}}</ref><ref name="pmid8816509">{{cite journal |vauthors=Oliver JH, Baron RL |title=Helical biphasic contrast-enhanced CT of the liver: technique, indications, interpretation, and pitfalls |journal=Radiology |volume=201 |issue=1 |pages=1–14 |year=1996 |pmid=8816509 |doi=10.1148/radiology.201.1.8816509 |url=}}</ref><ref name="pmid9169697">{{cite journal |vauthors=Yu JS, Kim KW, Sung KB, Lee JT, Yoo HS |title=Small arterial-portal venous shunts: a cause of pseudolesions at hepatic imaging |journal=Radiology |volume=203 |issue=3 |pages=737–42 |year=1997 |pmid=9169697 |doi=10.1148/radiology.203.3.9169697 |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>
*[[Inflammation|Inflammatory]] pseudotumors<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>
*[[Hemangioma|Liver hemangioma]]<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>
*[[Hepatoblastoma]] in children
*[[Inflammatory]] [[lesions]]<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>
*[[Mesenchymal]] [[hamartoma]] in children<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>
*Multiacinar regenerative [[nodule]]
*Macroregenerative nodule (low-grade dysplastic nodule)<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. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)|volume=30|issue=4|year=2017|pages=272–278|issn=2317-6326|doi=10.1590/0102-6720201700040011}}</ref>
*Nontumorous arterioportal shunts
*Pseudomass in chronic [[portal vein thrombosis]]
*[[Pyogenic]] [[Liver abscess|liver abscesses]]
*[[Pancreatic cancer]]
*[[Stomach cancer]]


'''Abbreviations:'''
<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]]
'''[[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]]
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==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Up-To-Date]]
 
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Medicine]]
[[Category:Gastroenterology]]
[[Category:Hepatology]]
[[Category:Hepatology]]
[[Category:Gastroenterology]]
[[Category:Oncology]]
[[Category:Up-To-Date]]
[[Category:Surgery]]
[[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 + − + + + + + + + − +
  • Normal
  • Hyperactive if obstruction present

Other symptoms:

Cholangiocarcinoma RUQ + − + + − − + − − − + Normal
  • Predisposes to pancreatic cancer
Pancreatic carcinoma MidEpigastric − − + + + − + − − − + Normal

Skin manifestations may include:

Focal nodular hyperplasia Diffuse ± − − ± − − + + − − − Normal
  • Open biopsy if diagnosis can not be established
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
  • Abnormal LFTs
Liver abscess RUQ + − + + − − + − − − − Normal
  • US
  • CT
Cirrhosis RUQ+Bloating + − + + − − + − − − − Normal US
  • Stigmata of liver disease
  • Cruveilhier- Baumgarten murmur
Inflammatory lesions RUQ ± − + + − − − − − − − Normal US
  • Nodular,shrunken or coarse liver
  • Stigmata of liver disease

References

  1. ↑ Choi BI, Kim TK, Han JK (1998). "MRI of clonorchiasis and cholangiocarcinoma". J Magn Reson Imaging. 8 (2): 359–66. PMID 9562062.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ {{cite
  8. ↑ 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.
  9. ↑ 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
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ 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. ↑ 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.
  14. ↑ 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.
  15. ↑ . doi:10.1102/1470-7330.2009.0015. Missing or empty |title= (help)
  16. ↑ 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.
  17. ↑ 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.
  18. ↑ 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.
  19. ↑ 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.
  20. ↑ 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.
  21. ↑ 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.
  22. ↑ 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.
  23. ↑ 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.
  24. ↑ 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.
  25. ↑ Gollapudi P, Chejfec G, Zarling EJ (1992). "Spontaneous regression of hepatic pseudotumor". Am. J. Gastroenterol. 87 (2): 214–7. PMID 1734701.
  26. ↑ 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.
  27. ↑ 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.
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