Inflammatory Pseudotumor of the Liver in Patients with Recurrent Pyogenic Cholangitis: CT-Histopathologic Correlation1
Kwon-Ha Yoon, MD 2,
Hyun Kwon Ha, MD,
Jin Seong Lee, MD,
Jae Hee Suh, MD,
Myung Hwan Kim, MD,
Pyo Nyun Kim, MD,
Moon-Gyu Lee, MD,
Ki Jung Yun, MD,
Suck-Chei Choi, MD,
Yong-Ho Nah, MD,
Chang Guhn Kim, MD,
Jong Jin Won, MD and
Yong Ho Auh, MD
1 From Depts of Diagnostic Radiology (K.H.Y., H.K.H., J.S.L., P.N.K., M.G.L., Y.H.A.), Diagnostic Pathology (J.H.S.), and Internal Medicine (M.H.K.), University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap-dong, Songpa-ku, Seoul 138-040, Korea; and Depts of Anatomic Pathology (K.J.Y.), Internal Medicine (S.C.C., Y.H.N.), and Diagnostic Radiology (C.G.K., J.J.W.), Wonkwang University Hospital, Iksan, Chonbuk, Korea. Received Mar 31, 1998; revision requested Jun 25; revision received Aug 18; accepted Nov 6. Address reprint requests to H.K.H.
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Figure 1a. Patient 3. Images obtained in a 39-year-old woman with inflammatory pseudotumor of the liver and recurrent pyogenic cholangitis who underwent cholecystectomy 5 years previously due to a gallbladder stone. (a) Contrast-enhanced CT image of the liver shows two multiseptate, hypoattenuating masses (straight arrows) with hyperattenuating internal septa in the lateral segment of the left lobe. Diffuse parenchymal enhancement is visible in the left lateral segment. Irregular biliary dilatation (curved arrow) and scattered pneumobilia (arrowheads) are also visible. (b) Photograph of the resected specimen shows multiple 4-cm, 3-cm, and 2-cm yellowish masses (large arrows) with scattered small nodules. The masses are multiseptate with fibrotic bands (arrowheads). Note the dilated and thickened intrahepatic duct with periductal fibrosis (small arrows).
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Figure 1b. Patient 3. Images obtained in a 39-year-old woman with inflammatory pseudotumor of the liver and recurrent pyogenic cholangitis who underwent cholecystectomy 5 years previously due to a gallbladder stone. (a) Contrast-enhanced CT image of the liver shows two multiseptate, hypoattenuating masses (straight arrows) with hyperattenuating internal septa in the lateral segment of the left lobe. Diffuse parenchymal enhancement is visible in the left lateral segment. Irregular biliary dilatation (curved arrow) and scattered pneumobilia (arrowheads) are also visible. (b) Photograph of the resected specimen shows multiple 4-cm, 3-cm, and 2-cm yellowish masses (large arrows) with scattered small nodules. The masses are multiseptate with fibrotic bands (arrowheads). Note the dilated and thickened intrahepatic duct with periductal fibrosis (small arrows).
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Figure 2a. Patient 5. Images obtained in a 65-year-old woman with inflammatory pseudotumor of the liver and recurrent pyogenic cholangitis who had simultaneous peripheral cholangiocarcinoma. (a) Contrast-enhanced CT image of the liver shows an ill-defined, multiseptate, hypoattenuating mass (white arrows) with internal septa in the left lateral segment. Irregularly dilated duct (black arrows) and hepatolithiasis (arrowhead) are also present. (b) Contrast-enhanced CT image obtained 2 cm above a shows a hypoattenuating mass (arrows) with irregular peripheral enhancement in the left medial segment. The lesion was proved to be cholangiocarcinoma at histopathologic analysis of the surgical specimen (not shown). (c) Photograph of the resected specimen shows a lobulated, yellowish mass with septate fibrotic bands (large arrows) and periductal, multiple abscesses (arrowheads). Black stones (small arrows) within the dilated hepatic duct and whitish, periductal fibrosis are also visible.
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Figure 2b. Patient 5. Images obtained in a 65-year-old woman with inflammatory pseudotumor of the liver and recurrent pyogenic cholangitis who had simultaneous peripheral cholangiocarcinoma. (a) Contrast-enhanced CT image of the liver shows an ill-defined, multiseptate, hypoattenuating mass (white arrows) with internal septa in the left lateral segment. Irregularly dilated duct (black arrows) and hepatolithiasis (arrowhead) are also present. (b) Contrast-enhanced CT image obtained 2 cm above a shows a hypoattenuating mass (arrows) with irregular peripheral enhancement in the left medial segment. The lesion was proved to be cholangiocarcinoma at histopathologic analysis of the surgical specimen (not shown). (c) Photograph of the resected specimen shows a lobulated, yellowish mass with septate fibrotic bands (large arrows) and periductal, multiple abscesses (arrowheads). Black stones (small arrows) within the dilated hepatic duct and whitish, periductal fibrosis are also visible.
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Figure 2c. Patient 5. Images obtained in a 65-year-old woman with inflammatory pseudotumor of the liver and recurrent pyogenic cholangitis who had simultaneous peripheral cholangiocarcinoma. (a) Contrast-enhanced CT image of the liver shows an ill-defined, multiseptate, hypoattenuating mass (white arrows) with internal septa in the left lateral segment. Irregularly dilated duct (black arrows) and hepatolithiasis (arrowhead) are also present. (b) Contrast-enhanced CT image obtained 2 cm above a shows a hypoattenuating mass (arrows) with irregular peripheral enhancement in the left medial segment. The lesion was proved to be cholangiocarcinoma at histopathologic analysis of the surgical specimen (not shown). (c) Photograph of the resected specimen shows a lobulated, yellowish mass with septate fibrotic bands (large arrows) and periductal, multiple abscesses (arrowheads). Black stones (small arrows) within the dilated hepatic duct and whitish, periductal fibrosis are also visible.
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Figure 3a. Patient 4. Images obtained in a 64-year-old man with inflammatory pseudotumor of the liver and recurrent pyogenic cholangitis who underwent cholecystectomy 4 years previously due to gallbladder stones. (a) Nonenhanced CT image shows an ill-defined, hypoattenuating mass in the medial segment of the left lobe (arrows). Scattered pneumobilia (arrowheads) is also present. (b) Contrast-enhanced CT image of the liver shows a lobulated mass with a central, hypoattenuating area and an iso- and hyperattenuating periphery (large arrows) and satellite, hypoattenuating nodules (small arrows). (c) Photograph of the resected specimen shows a well-circumscribed, round, and lobulated 4.0-cm mass. The lesions are diffusely tan with focally scattered necrotic and chalky yellow areas.
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Figure 3b. Patient 4. Images obtained in a 64-year-old man with inflammatory pseudotumor of the liver and recurrent pyogenic cholangitis who underwent cholecystectomy 4 years previously due to gallbladder stones. (a) Nonenhanced CT image shows an ill-defined, hypoattenuating mass in the medial segment of the left lobe (arrows). Scattered pneumobilia (arrowheads) is also present. (b) Contrast-enhanced CT image of the liver shows a lobulated mass with a central, hypoattenuating area and an iso- and hyperattenuating periphery (large arrows) and satellite, hypoattenuating nodules (small arrows). (c) Photograph of the resected specimen shows a well-circumscribed, round, and lobulated 4.0-cm mass. The lesions are diffusely tan with focally scattered necrotic and chalky yellow areas.
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Figure 3c. Patient 4. Images obtained in a 64-year-old man with inflammatory pseudotumor of the liver and recurrent pyogenic cholangitis who underwent cholecystectomy 4 years previously due to gallbladder stones. (a) Nonenhanced CT image shows an ill-defined, hypoattenuating mass in the medial segment of the left lobe (arrows). Scattered pneumobilia (arrowheads) is also present. (b) Contrast-enhanced CT image of the liver shows a lobulated mass with a central, hypoattenuating area and an iso- and hyperattenuating periphery (large arrows) and satellite, hypoattenuating nodules (small arrows). (c) Photograph of the resected specimen shows a well-circumscribed, round, and lobulated 4.0-cm mass. The lesions are diffusely tan with focally scattered necrotic and chalky yellow areas.
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Copyright © 1999 by the Radiological Society of North America.
