Pan W, Lin LJ, Meng ZW, Cai XR, Chen YL. Hepatic abscess caused by esophageal foreign body misdiagnosed as cystadenocarcinoma by magnetic resonance imaging: A case report. World J Clin Cases 2021; 9(23): 6781-6788 [PMID: 34447825 DOI: 10.12998/wjcc.v9.i23.6781]
Corresponding Author of This Article
Yan-Ling Chen, MD, Chief Doctor, Professor, Surgeon, Department of Hepatobiliary Surgery and Fujian Institute of Hepatobiliary Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou 350001, Fujian Province, China. chenyanling@fjmu.edu.cn
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Wei Pan, Ze-Wu Meng, Xin-Ran Cai, Yan-Ling Chen, Department of Hepatobiliary Surgery and Fujian Institute of Hepatobiliary Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
Wei Pan, Ze-Wu Meng, Xin-Ran Cai, Yan-Ling Chen, Fujian Medical University Cancer Center, Fuzhou 350001, Fujian Province, China
Li-Jing Lin, Department of Endocrinology, Union Hospital, Fujian Institute of Endocrinology, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
Author contributions: Pan W and Lin LJ contributed equally to this manuscript; Pan W, Meng ZW, Cai XR, and Chen YL participated in the patient’s clinical management; Pan W performed the patient’s endoscopic examination and drafted the manuscript; Chen YL served as the attending physician in charge of the patient, was responsible for the literature review, and revised the article for important intellectual content; Lin LJ performed the histopathological analysis; Chen YL and Cai XR provided guidance for the case diagnosis.
Supported byNational Natural Science Foundation of China, No. 81672468; and Startup Fund for Scientific Research, Fujian Medical University, No. 2018QH1031.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: Dr. Chen reports grants from National Natural Science Foundation of China and from Fujian Medical University, during the conduct of the study.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan-Ling Chen, MD, Chief Doctor, Professor, Surgeon, Department of Hepatobiliary Surgery and Fujian Institute of Hepatobiliary Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou 350001, Fujian Province, China. chenyanling@fjmu.edu.cn
Received: January 16, 2021 Peer-review started: January 16, 2021 First decision: May 5, 2021 Revised: May 11, 2021 Accepted: July 5, 2021 Article in press: July 5, 2021 Published online: August 16, 2021 Processing time: 201 Days and 11.9 Hours
Abstract
BACKGROUND
Foreign bodies stuck in the throat and esophagus can be discharged through the digestive tract. Esophageal-lodged foreign bodies can cause secondary injury or detrimental response, with hepatic abscess being one such, albeit rare, outcome. Review and discussion of the few case reports on such instances will help to improve the overall understanding of such conditions and aid in differential diagnosis to improve patient outcome.
CASE SUMMARY
A 51-year-old female patient with pre-existing diabetes visited our hospital following a 15-d experience of chills and fever. Both plain and enhanced magnetic resonance imaging and color Doppler ultrasound examination of the liver and gallbladder revealed a space-occupying lesion in the caudate lobe of the liver (7.8 cm × 6.0 cm × 5.0 cm). Initially, a malignant tumor was suspected, but differential diagnosis was unable to exclude the possibility of hepatic abscess. Conservative anti-infection therapy produced a less than ideal outcome. Additional examination by hepatobiliary imaging with computed tomography suggested a foreign body present in the upper abdomen and hepatic abscess, and subsequent endoscopy revealed a sinus tract in the anterior wall of the duodenal bulb. Therefore, surgery was performed to remove the object (fishbone) and drain the abscess. After a 2-wk uneventful recovery, the patient was discharged. The final diagnosis was foreign body-induced hepatic abscess of the caudate lobe.
CONCLUSION
Differential diagnosis is important for hepatic masses, and systematic examination and physician awareness can aid in diagnosing and curing such rare conditions.
Core Tip: Most foreign bodies that become lodged in the throat and esophagus can be discharged uneventfully through the digestive tract, but rare patients will suffer gastrointestinal perforation. We report here the case of an elderly woman whose hepatic abscess caused by transverse of an esophageal foreign body was misdiagnosed as cystadenocarcinoma. The magnetic resonance imaging diagnosis of malignant tumor was not supported by computed tomography and endoscopy findings. Ultimately, surgery and 2-wk anti-infective drug course resolved this case of foreign body-induced hepatic abscess of the caudate lobe. This case emphasizes the importance of differential diagnosis for hepatic masses.
