2006 Volume 39 Issue 6 Pages 666-671
We report a case of inflammatory pseudotumor of the liver with septic shock and disseminated intravascular coagulation. A 51-year-old woman admitted for fever and right hypochondralgia and referred due to a hepatic mass lesion detected by abdominal computed tomography (CT) was found on admission to have blood pressure of 77/51mmHg and laboratory data showing disseminated intravascular coagulation with decreased platelet counts and increased FDP. Imaging diagnosis following ultrasonography (US), CT, and magnetic resonance imaging showed a space-occupying lesion 8cm in diameter in the right hepatic lobe. Selective hepatic angiography showed tumor staining and occlusion of the anterior branch of the right portal vein. Fine needle aspiration biopsy under US to determine a definitive diagnosis showed that the lesion consisted of numerous lymphocytes and neutrophils without malignant pathological features. Cultures from the lesion grew Streptococcus species, leading to suspicion of an inflammatory pseudotumor. Conservative therapy using antibiotics had no effect on the inflammatory reaction, necessitating exploratory surgery and right hepatectomy and cholecystectomy. The cut surface of the lesion showed a yellowish white solid tumor with scattered microabscesses. Pathological examination yielded a definitive diagnosis of inflammatory pseudotumor. The patient recovered without complications and remains well without symptom recurrence in the 3 years since her operation.
