Korean J Gastroenterol.  2010 Oct;56(4):264-267. 10.4166/kjg.2010.56.4.264.

A Case of Hepatic Congestion Due to Right Heart Failure Mimicking Liver Tumor

Affiliations
  • 1Department of Internal Medicine, Yonsei Liver Cancer Special Clinic, Yonsei University College of Medicine, Seoul, Korea. dyk1025@yuhs.ac

Abstract

This report describes a patient with hepatic congestion due to right heart failure mimicking liver tumor. The patient had a history of breast cancer and left total mastectomy 30 years ago, tricuspid valve regurgitation and tricuspid valve replacement 4 years ago. Three years ago, abdominal contrast-enhanced computed tomography (CT) was performed to evaluate inguinal hernia, which revealed multiple small hepatic nodules. After 1 year, the number and size of liver nodules were increased in CT scan. The patient underwent gun biopsy and histopathology revealed sinusoid enlargement. The patient recently had jaundice, abdominal distension, and peripheral edema. Liver dynamic CT scan was done to evaluate the palpable liver. The number and size of liver nodules were more increased in CT than 2 years ago. In magnetic resonance imaging (MRI), numerous variable sized ill-defined nodules replacing entire liver with progressing centripetal enhancement, which were suggestive of malignancy such as angiosarcoma, were noted. MRI finding suspects malignancy or hemangiosarcoma. Finally, the patient received repeated gun biopsy, and histopathology revealed findings compatible with hepatic congestion.

Keyword

Hepatic congestion; Liver tumor; Right-sided heart failure

MeSH Terms

Biopsy, Needle
Female
Heart Failure/*complications
Humans
Liver Diseases/*diagnosis/etiology/pathology
Liver Neoplasms/diagnosis
Magnetic Resonance Imaging
Middle Aged
Tomography, X-Ray Computed

Figure

  • Fig. 1. (A) Three years ago, CT showed multiple, variable sized, and ill-defined low density nodule scattering through entire liver. (B) Two years ago, CT showed variable sized and ill-defined low density nodule increased in size and number. (C) At this time, CT showed previously noted low density nodules in both lobes of the liver increased in size and number and dilated IVC and hepatic veins, inhomogenous enhancement of hepatic parenchyma. (D) In T2 weighted MRI scan, numerous nodules replaced entire liver with progressing centripetal enhancement.

  • Fig. 2. (A) Initial liver specimen showed sinusoidal dilatation and fibrous septal containing ductular proliferation and abnormal vessel (H&E, ×200). (B) Following liver specimen showed marked sinusoidal dilatation with focal sinusoidal fibrin thrombi, portal fibrosis and focal ductular proliferation (H&E, ×100).


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