Biomedical subjects
Publications and source records attributed to A Blachar.
We describe a case of fatal fulminant hepatic infection with gas replacement of the hepatic parenchyma and no evidence of a liquified abscess in a diabetic patient: a case of "emphysematous hepatitis," the hepatic equivalent of emphysematous pyelonephritis. Computed tomography and clinical findings are described.
Retraction of the liver capsule may be associated with a diverse spectrum of benign and malignant hepatic abnormalities. These include primary malignant neoplasms (epithelioid hemangioendothelioma, hepatocellular carcinoma, cholangiocarcinoma), secondary malignant neoplasms before and after treatment, and hepatic hemangioma, especially in cirrhotic livers. Other etiologies include confluent fibrosis in cirrhotic livers, chronic biliary obstruction (as can be seen in primary sclerosing cholangitis), and traumatic hepatic injury (iatrogenic and noniatrogenic). Because several recent studies have incorrectly reported hepatic capsular retraction as a specific sign of hepatic malignancy, it is important to understand the imaging appearances of the various etiologies associated with this sign to avoid misdiagnosis that may adversely affect the therapeutic approach.
Hepatocellular adenoma is a rare benign lesion that is most often seen in young women with a history of oral contraceptive use. It is typically solitary, although multiple lesions have been reported, particularly in patients with glycogen storage disease and liver adenomatosis. Because of the risk of hemorrhage and malignant transformation, hepatocellular adenomas must be identified and treated promptly. At pathologic analysis, hepatocellular adenoma is usually a well-circumscribed, nonlobulated lesion, and at gross examination, resected adenomas frequently demonstrate areas of hemorrhage and infarction. Most adenomas are not specifically diagnosed at ultrasonography (US) and are usually further evaluated with computed tomography (CT) or other imaging modalities. Color Doppler US may help differentiate hepatocellular adenoma from focal nodular hyperplasia. Multiphasic helical CT allows more accurate detection and characterization of focal hepatic lesions. Hepatocellular adenomas are typically bright on T1-weighted magnetic resonance images and predominantly hyperintense relative to liver on T2-weighted images. The prognosis of hepatic adenoma is not well established. Criteria that guide treatment include the number and size of the lesions, the presence of symptoms, and the surgical risk incurred by the patient. Understanding the imaging appearance of hepatocellular adenoma can help avoid misdiagnosis and facilitate prompt, effective treatment.