HCV, Acute, LT : Liver Abscess Mimicking Liver Metastasis

Background: In patient with mass in liver, it will suspected as hepatoma, cholangiocarcinoma, liver metastasis or liver abscess. Differential diagnosis of these disease is not simply. We present a case of liver abscess that mimicked metastasis in patient with liver mass. Case: A 77-year-old woman was visited to an OPD for evaluation and biopsy of liver mass. The patient had no history of alcoholic use. She had abdominal pain and febrile sense before 3 days. She visited local medical clinic and about 5cm sized liver mass was detected in liver ultrasonography. She was transferred to our hospital. Initial vital sign were: blood pressure 110/70 mmHg, heart rate of 88 beats/min, respiratory rate of 20 breaths/min, and temperature of 36.8 μL. The patient was alert and fully oriented. Laboratory studies revealed a white blood cell count 11,110/μL, hematocrit of 34.7%, platelets of 124,000, BUN of 27 mg/dL, creatinine of 0.8 mg/dL, AST of 53 IU/L, ALT of 62 U/L, serum albumin of 3.3 g/dL, alpha-fetoprotein of 0.6 ng/mL, CA19-9 of 14.760 U/mL. Initial abdominal computed tomography showed about 7×5 cm sized liver mass on left hepatic lobe. The patient made reservation for liver biopsy and taken antibiotics. After 2 weeks, the patient was visited to an OPD again for liver biopsy. Follow up abdominal computed tomography revealed that the mass had decreased in size to 3×2 cm. Follow up laboratory studies revealed a white blood cell count 6,840/μL, hematocrit of 32.5%, platelet 477,000, AST of 24 U/L, ALT of 10 U/L, serum albumin of 3.9 g/dL, CA19-9 of 6.6 U/mL, amoeba antibody was positive. We used metronidazole for 44 days, and the mass disappeared at follow up abdominal computed tomography. Now, the patient is still healthy without any complication. Conclusions: The reason of liver mass is variable. For new lesions in liver, biopsy is commonly performed to confirm the diagnosis. Liver abscess typically is the result of a pyogenic or amoebic infection and cause symptoms including fever and leukocytosis. But liver abscess does not have any pathognomonic imaging appearance. Infectious etiology is generally suspected based on a combination of clinical symptoms, laboratory abnormalities, medical history and corresponding imaging findings. Our case may serve as precautionary example that liver abscess can mimic metastasis. So, to diagnosis of liver mass we should consider another symptoms and signs.