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How to diagnose peliosis hepatis

The article reported a 44-year-old woman who presented with upper right abdominal pain for four months. After hepatic lobectomy of the right lobe, histopathological diagnosis of the isodensity mass in segment V and VI and hypodensity lesion in segment VIII was peliosis hepatic and gumma, respectively.

This study, performed by a team led by Professor Wei-Xia Chen, is described in a research article to be published on March 28, 2008 in the World Journal of Gastroenterology. In the view of Dr. Wei-Xia Chen, an associated professor from West China Hospital of Sichuan University in China, this case was unusual in several respects: (1) peliosis hepatis with syphilitic gumma of the liver, (2) isodensity to the adjacent liver parenchyma on unenhanced and on dual-phase CT scanning, (3) pseudotumoral appearance.

The imaging findings of peliosis hepatis are variable depending on the pathologic patterns, lesion size, the extent of communication with sinusoids, and the complications such as thrombosis or hemorrhage within lesions. On unenhanced CT, peliotic lesions usually appear as multiple areas of low attenuation. On contrast enhanced imagings, the lesions show a predominantly central enhancement during the arterial phase and slow centrifugal progression during the portal-venous and delayed phases (the so-called target sign) or an unusual centripetal enhancement pattern similar to hemangioma, from the periphery to the centre. The lesion in this case appeared isodensity, ill-defined on unenhanced scanning and synchronous enhancement with the liver parenchyma on enhanced CT. The enhancement pattern was different to that in previous reports, possibly because of the difference in the severity of sinusoids dilatation.

The case in this article is surely worth the attention of both doctors and the public. The authors suggested that peliosis hepatis should be considered in the differential diagnosis of an atypical focal hepatic lesion. Besides looking into the patient's medical history in detail to find possible causes, awareness of the imaging features of peliosis hepatis should be taken into account during the diagnosis.


Contact: Jing Zhu
World Journal of Gastroenterology

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