Hepatocellular carcinoma differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Hepatocellular carcinoma}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Hepatocellular_carcinoma]]


{{CMG}} {{AE}} {{SH}}  
{{CMG}} {{AE}} {{SH}}  
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==Overview==
==Overview==


Hepatocellular [[carcinoma]] must be differentiated from other diseases that cause [[abdominal pain]], [[jaundice]], and [[weight loss]], such as [[hepatitis B]], [[hepatitis C]], liver cirrhosis, and [[pancreatitis]].
Hepatocellular [[carcinoma]] must be differentiated from other diseases that cause [[abdominal pain]], [[jaundice]], and [[weight loss]], such as liver cirrhosis and [[pancreatitis]].
==Differentiating Hepatocellular Carcinoma from other Diseases==
==Differentiating Hepatocellular Carcinoma from other Diseases==
Hepatocellular carcinoma must be differentiated from the following diseases:<ref name="pmid26770920">{{cite journal |vauthors=Kim TK, Lee E, Jang HJ |title=Imaging findings of mimickers of hepatocellular carcinoma |journal=Clin Mol Hepatol |volume=21 |issue=4 |pages=326–43 |year=2015 |pmid=26770920 |pmc=4712159 |doi=10.3350/cmh.2015.21.4.326 |url=}}</ref><ref name="Ferrell2000">{{cite journal|last1=Ferrell|first1=Linda|title=Liver Pathology: Cirrhosis, Hepatitis and Primary Liver Tumors. Update and Diagnostic Problems|journal=Modern Pathology|volume=13|issue=6|year=2000|pages=679–704|issn=0893-3952|doi=10.1038/modpathol.3880119}}</ref><ref name="KimLee2015">{{cite journal|last1=Kim|first1=Tae Kyoung|last2=Lee|first2=Eunchae|last3=Jang|first3=Hyun-Jung|title=Imaging findings of mimickers of hepatocellular carcinoma|journal=Clinical and Molecular Hepatology|volume=21|issue=4|year=2015|pages=326|issn=2287-2728|doi=10.3350/cmh.2015.21.4.326}}</ref><ref name="DooLee2009">{{cite journal|last1=Doo|first1=Kyung Won|last2=Lee|first2=Chang Hee|last3=Choi|first3=Jae Woong|last4=Lee|first4=Jongmee|last5=Kim|first5=Kyeong Ah|last6=Park|first6=Cheol Min|title=“Pseudo Washout” Sign in High-Flow Hepatic Hemangioma on Gadoxetic Acid Contrast-Enhanced MRI Mimicking Hypervascular Tumor|journal=American Journal of Roentgenology|volume=193|issue=6|year=2009|pages=W490–W496|issn=0361-803X|doi=10.2214/AJR.08.1732}}</ref><ref name="pmid17510541">{{cite journal |vauthors=Zech CJ, Herrmann KA, Reiser MF, Schoenberg SO |title=MR imaging in patients with suspected liver metastases: value of liver-specific contrast agent Gd-EOB-DTPA |journal=Magn Reson Med Sci |volume=6 |issue=1 |pages=43–52 |year=2007 |pmid=17510541 |doi= |url=}}</ref><ref name="ChengTsai1995">{{cite journal|last1=Cheng|first1=H C|last2=Tsai|first2=S H|last3=Chiang|first3=J H|last4=Chang|first4=C Y|title=Hyalinized liver hemangioma mimicking malignant tumor at MR imaging.|journal=American Journal of Roentgenology|volume=165|issue=4|year=1995|pages=1016–1017|issn=0361-803X|doi=10.2214/ajr.165.4.7676959}}</ref><ref name="pmid1370873">{{cite journal |vauthors=Haratake J, Horie A, Nagafuchi Y |title=Hyalinized hemangioma of the liver |journal=Am. J. Gastroenterol. |volume=87 |issue=2 |pages=234–6 |year=1992 |pmid=1370873 |doi= |url=}}</ref><ref name="TakayasuMoriyama1986">{{cite journal|last1=Takayasu|first1=K|last2=Moriyama|first2=N|last3=Shima|first3=Y|last4=Muramatsu|first4=Y|last5=Yamada|first5=T|last6=Makuuchi|first6=M|last7=Yamasaki|first7=S|last8=Hirohashi|first8=S|title=Atypical radiographic findings in hepatic cavernous hemangioma: correlation with histologic features|journal=American Journal of Roentgenology|volume=146|issue=6|year=1986|pages=1149–1153|issn=0361-803X|doi=10.2214/ajr.146.6.1149}}</ref><ref name="pmid11039718">{{cite journal |vauthors=Yamashita Y, Shimada M, Taguchi K, Gion T, Hasegawa H, Utsunomiya T, Hamatsu T, Matsumata T, Sugimachi K |title=Hepatic sclerosing hemangioma mimicking a metastatic liver tumor: report of a case |journal=Surg. Today |volume=30 |issue=9 |pages=849–52 |year=2000 |pmid=11039718 |doi= |url=}}</ref><ref name="KimLee20152">{{cite journal|last1=Kim|first1=Tae Kyoung|last2=Lee|first2=Eunchae|last3=Jang|first3=Hyun-Jung|title=Imaging findings of mimickers of hepatocellular carcinoma|journal=Clinical and Molecular Hepatology|volume=21|issue=4|year=2015|pages=326|issn=2287-2728|doi=10.3350/cmh.2015.21.4.326}}</ref>
Hepatocellular carcinoma must be differentiated from the following diseases:<ref name="pmid26770920">{{cite journal |vauthors=Kim TK, Lee E, Jang HJ |title=Imaging findings of mimickers of hepatocellular carcinoma |journal=Clin Mol Hepatol |volume=21 |issue=4 |pages=326–43 |year=2015 |pmid=26770920 |pmc=4712159 |doi=10.3350/cmh.2015.21.4.326 |url=}}</ref><ref name="Ferrell2000">{{cite journal|last1=Ferrell|first1=Linda|title=Liver Pathology: Cirrhosis, Hepatitis and Primary Liver Tumors. Update and Diagnostic Problems|journal=Modern Pathology|volume=13|issue=6|year=2000|pages=679–704|issn=0893-3952|doi=10.1038/modpathol.3880119}}</ref><ref name="KimLee2015">{{cite journal|last1=Kim|first1=Tae Kyoung|last2=Lee|first2=Eunchae|last3=Jang|first3=Hyun-Jung|title=Imaging findings of mimickers of hepatocellular carcinoma|journal=Clinical and Molecular Hepatology|volume=21|issue=4|year=2015|pages=326|issn=2287-2728|doi=10.3350/cmh.2015.21.4.326}}</ref><ref name="DooLee2009">{{cite journal|last1=Doo|first1=Kyung Won|last2=Lee|first2=Chang Hee|last3=Choi|first3=Jae Woong|last4=Lee|first4=Jongmee|last5=Kim|first5=Kyeong Ah|last6=Park|first6=Cheol Min|title=“Pseudo Washout” Sign in High-Flow Hepatic Hemangioma on Gadoxetic Acid Contrast-Enhanced MRI Mimicking Hypervascular Tumor|journal=American Journal of Roentgenology|volume=193|issue=6|year=2009|pages=W490–W496|issn=0361-803X|doi=10.2214/AJR.08.1732}}</ref><ref name="pmid17510541">{{cite journal |vauthors=Zech CJ, Herrmann KA, Reiser MF, Schoenberg SO |title=MR imaging in patients with suspected liver metastases: value of liver-specific contrast agent Gd-EOB-DTPA |journal=Magn Reson Med Sci |volume=6 |issue=1 |pages=43–52 |year=2007 |pmid=17510541 |doi= |url=}}</ref><ref name="ChengTsai1995">{{cite journal|last1=Cheng|first1=H C|last2=Tsai|first2=S H|last3=Chiang|first3=J H|last4=Chang|first4=C Y|title=Hyalinized liver hemangioma mimicking malignant tumor at MR imaging.|journal=American Journal of Roentgenology|volume=165|issue=4|year=1995|pages=1016–1017|issn=0361-803X|doi=10.2214/ajr.165.4.7676959}}</ref><ref name="pmid1370873">{{cite journal |vauthors=Haratake J, Horie A, Nagafuchi Y |title=Hyalinized hemangioma of the liver |journal=Am. J. Gastroenterol. |volume=87 |issue=2 |pages=234–6 |year=1992 |pmid=1370873 |doi= |url=}}</ref><ref name="TakayasuMoriyama1986">{{cite journal|last1=Takayasu|first1=K|last2=Moriyama|first2=N|last3=Shima|first3=Y|last4=Muramatsu|first4=Y|last5=Yamada|first5=T|last6=Makuuchi|first6=M|last7=Yamasaki|first7=S|last8=Hirohashi|first8=S|title=Atypical radiographic findings in hepatic cavernous hemangioma: correlation with histologic features|journal=American Journal of Roentgenology|volume=146|issue=6|year=1986|pages=1149–1153|issn=0361-803X|doi=10.2214/ajr.146.6.1149}}</ref><ref name="pmid11039718">{{cite journal |vauthors=Yamashita Y, Shimada M, Taguchi K, Gion T, Hasegawa H, Utsunomiya T, Hamatsu T, Matsumata T, Sugimachi K |title=Hepatic sclerosing hemangioma mimicking a metastatic liver tumor: report of a case |journal=Surg. Today |volume=30 |issue=9 |pages=849–52 |year=2000 |pmid=11039718 |doi= |url=}}</ref><ref name="KimLee20152">{{cite journal|last1=Kim|first1=Tae Kyoung|last2=Lee|first2=Eunchae|last3=Jang|first3=Hyun-Jung|title=Imaging findings of mimickers of hepatocellular carcinoma|journal=Clinical and Molecular Hepatology|volume=21|issue=4|year=2015|pages=326|issn=2287-2728|doi=10.3350/cmh.2015.21.4.326}}</ref>
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*[[Adenoma]]
*[[Adenoma]]
*Borderline (high-grade [[Dysplasia|dysplastic]]) [[Nodule (medicine)|nodule]]
*Borderline (high-grade [[Dysplasia|dysplastic]]) [[Nodule (medicine)|nodule]]
*[[Cholangiocarcinoma]]<ref name="KimChoi1997">{{cite journal|last1=Kim|first1=T K|last2=Choi|first2=B I|last3=Han|first3=J K|last4=Jang|first4=H J|last5=Cho|first5=S G|last6=Han|first6=M C|title=Peripheral cholangiocarcinoma of the liver: two-phase spiral CT findings.|journal=Radiology|volume=204|issue=2|year=1997|pages=539–543|issn=0033-8419|doi=10.1148/radiology.204.2.9240550}}</ref><ref name="pmid9562062">{{cite journal |vauthors=Choi BI, Kim TK, Han JK |title=MRI of clonorchiasis and cholangiocarcinoma |journal=J Magn Reson Imaging |volume=8 |issue=2 |pages=359–66 |year=1998 |pmid=9562062 |doi= |url=}}</ref><ref name="GuoXu2015">{{cite journal|last1=Guo|first1=Le-Hang|last2=Xu|first2=Hui-Xiong|title=Contrast-Enhanced Ultrasound in the Diagnosis of Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma: Controversy over the ASSLD Guideline|journal=BioMed Research International|volume=2015|year=2015|pages=1–5|issn=2314-6133|doi=10.1155/2015/349172}}</ref><ref name="WilsonKim2007">{{cite journal|last1=Wilson|first1=Stephanie R.|last2=Kim|first2=Tae Kyoung|last3=Jang|first3=Hyun-Jung|last4=Burns|first4=Peter N.|title=Enhancement Patterns of Focal Liver Masses: Discordance Between Contrast-Enhanced Sonography and Contrast-Enhanced CT and MRI|journal=American Journal of Roentgenology|volume=189|issue=1|year=2007|pages=W7–W12|issn=0361-803X|doi=10.2214/AJR.06.1060}}</ref>
*[[Cholangiocarcinoma]]<ref name="KimChoi1997">{{cite journal|last1=Kim|first1=T K|last2=Choi|first2=B I|last3=Han|first3=J K|last4=Jang|first4=H J|last5=Cho|first5=S G|last6=Han|first6=M C|title=Peripheral cholangiocarcinoma of the liver: two-phase spiral CT findings.|journal=Radiology|volume=204|issue=2|year=1997|pages=539–543|issn=0033-8419|doi=10.1148/radiology.204.2.9240550}}</ref><ref name="pmid9562062">{{cite journal |vauthors=Choi BI, Kim TK, Han JK |title=MRI of clonorchiasis and cholangiocarcinoma |journal=J Magn Reson Imaging |volume=8 |issue=2 |pages=359–66 |year=1998 |pmid=9562062 |doi= |url=}}</ref><ref name="GuoXu2015">{{cite journal|last1=Guo|first1=Le-Hang|last2=Xu|first2=Hui-Xiong|title=Contrast-Enhanced Ultrasound in the Diagnosis of Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma: Controversy over the ASSLD Guideline|journal=BioMed Research International|volume=2015|year=2015|pages=1–5|issn=2314-6133|doi=10.1155/2015/349172}}</ref><ref name="WilsonKim2007">{{cite journal|last1=Wilson|first1=Stephanie R.|last2=Kim|first2=Tae Kyoung|last3=Jang|first3=Hyun-Jung|last4=Burns|first4=Peter N.|title=Enhancement Patterns of Focal Liver Masses: Discordance Between Contrast-Enhanced Sonography and Contrast-Enhanced CT and MRI|journal=American Journal of Roentgenology|volume=189|issue=1|year=2007|pages=W7–W12|issn=0361-803X|doi=10.2214/AJR.06.1060}}</ref>  
*Confluent [[fibrosis]]<ref name="pmid8511316">{{cite journal |vauthors=Ohtomo K, Baron RL, Dodd GD, Federle MP, Miller WJ, Campbell WL, Confer SR, Weber KM |title=Confluent hepatic fibrosis in advanced cirrhosis: appearance at CT |journal=Radiology |volume=188 |issue=1 |pages=31–5 |year=1993 |pmid=8511316 |doi=10.1148/radiology.188.1.8511316 |url=}}</ref><ref name="HussainSyed2004">{{cite journal|last1=Hussain|first1=Hero K.|last2=Syed|first2=Ibrahim|last3=Nghiem|first3=Hanh V.|last4=Johnson|first4=Timothy D.|last5=Carlos|first5=Ruth C.|last6=Weadock|first6=William J.|last7=Francis|first7=Isaac R.|title=T2-weighted MR Imaging in the Assessment of Cirrhotic Liver|journal=Radiology|volume=230|issue=3|year=2004|pages=637–644|issn=0033-8419|doi=10.1148/radiol.2303020921}}</ref><ref name="pmid8234718">{{cite journal |vauthors=Ohtomo K, Baron RL, Dodd GD, Federle MP, Ohtomo Y, Confer SR |title=Confluent hepatic fibrosis in advanced cirrhosis: evaluation with MR imaging |journal=Radiology |volume=189 |issue=3 |pages=871–4 |year=1993 |pmid=8234718 |doi=10.1148/radiology.189.3.8234718 |url=}}</ref><ref name="pmid19380559">{{cite journal |vauthors=Brancatelli G, Baron RL, Federle MP, Sparacia G, Pealer K |title=Focal confluent fibrosis in cirrhotic liver: natural history studied with serial CT |journal=AJR Am J Roentgenol |volume=192 |issue=5 |pages=1341–7 |year=2009 |pmid=19380559 |doi=10.2214/AJR.07.2782 |url=}}</ref><ref name="pmid15050225">{{cite journal |vauthors=Kelekis NL, Makri E, Vassiou A, Patsiaoura K, Spiridakis M, Dalekos GN |title=Confluent hepatic fibrosis as the presenting imaging sign in nonadvanced alcoholic cirrhosis |journal=Clin Imaging |volume=28 |issue=2 |pages=124–7 |year=2004 |pmid=15050225 |doi=10.1016/S0899-7071(03)00243-2 |url=}}</ref><ref name="pmid9880618">{{cite journal |vauthors=Ooi CG, Chan KL, Peh WC, Saing H, Ngan H |title=Confluent hepatic fibrosis in monozygotic twins |journal=Pediatr Radiol |volume=29 |issue=1 |pages=53–5 |year=1999 |pmid=9880618 |doi=10.1007/s002470050534 |url=}}</ref><ref name="pmid23688409">{{cite journal |vauthors=Park YS, Lee CH, Kim BH, Lee J, Choi JW, Kim KA, Ahn JH, Park CM |title=Using Gd-EOB-DTPA-enhanced 3-T MRI for the differentiation of infiltrative hepatocellular carcinoma and focal confluent fibrosis in liver cirrhosis |journal=Magn Reson Imaging |volume=31 |issue=7 |pages=1137–42 |year=2013 |pmid=23688409 |doi=10.1016/j.mri.2013.01.011 |url=}}</ref>
*Confluent [[fibrosis]]<ref name="pmid8511316">{{cite journal |vauthors=Ohtomo K, Baron RL, Dodd GD, Federle MP, Miller WJ, Campbell WL, Confer SR, Weber KM |title=Confluent hepatic fibrosis in advanced cirrhosis: appearance at CT |journal=Radiology |volume=188 |issue=1 |pages=31–5 |year=1993 |pmid=8511316 |doi=10.1148/radiology.188.1.8511316 |url=}}</ref><ref name="HussainSyed2004">{{cite journal|last1=Hussain|first1=Hero K.|last2=Syed|first2=Ibrahim|last3=Nghiem|first3=Hanh V.|last4=Johnson|first4=Timothy D.|last5=Carlos|first5=Ruth C.|last6=Weadock|first6=William J.|last7=Francis|first7=Isaac R.|title=T2-weighted MR Imaging in the Assessment of Cirrhotic Liver|journal=Radiology|volume=230|issue=3|year=2004|pages=637–644|issn=0033-8419|doi=10.1148/radiol.2303020921}}</ref><ref name="pmid8234718">{{cite journal |vauthors=Ohtomo K, Baron RL, Dodd GD, Federle MP, Ohtomo Y, Confer SR |title=Confluent hepatic fibrosis in advanced cirrhosis: evaluation with MR imaging |journal=Radiology |volume=189 |issue=3 |pages=871–4 |year=1993 |pmid=8234718 |doi=10.1148/radiology.189.3.8234718 |url=}}</ref><ref name="pmid19380559">{{cite journal |vauthors=Brancatelli G, Baron RL, Federle MP, Sparacia G, Pealer K |title=Focal confluent fibrosis in cirrhotic liver: natural history studied with serial CT |journal=AJR Am J Roentgenol |volume=192 |issue=5 |pages=1341–7 |year=2009 |pmid=19380559 |doi=10.2214/AJR.07.2782 |url=}}</ref><ref name="pmid15050225">{{cite journal |vauthors=Kelekis NL, Makri E, Vassiou A, Patsiaoura K, Spiridakis M, Dalekos GN |title=Confluent hepatic fibrosis as the presenting imaging sign in nonadvanced alcoholic cirrhosis |journal=Clin Imaging |volume=28 |issue=2 |pages=124–7 |year=2004 |pmid=15050225 |doi=10.1016/S0899-7071(03)00243-2 |url=}}</ref><ref name="pmid9880618">{{cite journal |vauthors=Ooi CG, Chan KL, Peh WC, Saing H, Ngan H |title=Confluent hepatic fibrosis in monozygotic twins |journal=Pediatr Radiol |volume=29 |issue=1 |pages=53–5 |year=1999 |pmid=9880618 |doi=10.1007/s002470050534 |url=}}</ref><ref name="pmid23688409">{{cite journal |vauthors=Park YS, Lee CH, Kim BH, Lee J, Choi JW, Kim KA, Ahn JH, Park CM |title=Using Gd-EOB-DTPA-enhanced 3-T MRI for the differentiation of infiltrative hepatocellular carcinoma and focal confluent fibrosis in liver cirrhosis |journal=Magn Reson Imaging |volume=31 |issue=7 |pages=1137–42 |year=2013 |pmid=23688409 |doi=10.1016/j.mri.2013.01.011 |url=}}</ref>
*[[Focal nodular hyperplasia]]<ref name="pmid11906867">{{cite journal |vauthors=Brancatelli G, Federle MP, Grazioli L, Golfieri R, Lencioni R |title=Large regenerative nodules in Budd-Chiari syndrome and other vascular disorders of the liver: CT and MR imaging findings with clinicopathologic correlation |journal=AJR Am J Roentgenol |volume=178 |issue=4 |pages=877–83 |year=2002 |pmid=11906867 |doi=10.2214/ajr.178.4.1780877 |url=}}</ref><ref name="pmid12110714">{{cite journal |vauthors=Brancatelli G, Federle MP, Grazioli L, Golfieri R, Lencioni R |title=Benign regenerative nodules in Budd-Chiari syndrome and other vascular disorders of the liver: radiologic-pathologic and clinical correlation |journal=Radiographics |volume=22 |issue=4 |pages=847–62 |year=2002 |pmid=12110714 |doi=10.1148/radiographics.22.4.g02jl17847 |url=}}</ref><ref name="NewerlaSchaeffer2012">{{cite journal|last1=Newerla|first1=Caroline|last2=Schaeffer|first2=Fabienne|last3=Terracciano|first3=Luigi|last4=Hohmann|first4=Joachim|title=Multiple FNH-Like Lesions in a Patient with Chronic Budd-Chiari Syndrome: Gd-EOB-Enhanced MRI and BR1 CEUS Findings|journal=Case Reports in Radiology|volume=2012|year=2012|pages=1–5|issn=2090-6862|doi=10.1155/2012/685486}}</ref><ref name="pmid22618456">{{cite journal |vauthors=Yoneda N, Matsui O, Kitao A, Kita R, Kozaka K, Koda W, Kobayashi S, Gabata T, Ikeda H, Sato Y, Nakanuma Y |title=Hepatocyte transporter expression in FNH and FNH-like nodule: correlation with signal intensity on gadoxetic acid enhanced magnetic resonance images |journal=Jpn J Radiol |volume=30 |issue=6 |pages=499–508 |year=2012 |pmid=22618456 |doi=10.1007/s11604-012-0085-4 |url=}}</ref>
*[[Focal nodular hyperplasia]]<ref name="pmid11906867">{{cite journal |vauthors=Brancatelli G, Federle MP, Grazioli L, Golfieri R, Lencioni R |title=Large regenerative nodules in Budd-Chiari syndrome and other vascular disorders of the liver: CT and MR imaging findings with clinicopathologic correlation |journal=AJR Am J Roentgenol |volume=178 |issue=4 |pages=877–83 |year=2002 |pmid=11906867 |doi=10.2214/ajr.178.4.1780877 |url=}}</ref><ref name="pmid12110714">{{cite journal |vauthors=Brancatelli G, Federle MP, Grazioli L, Golfieri R, Lencioni R |title=Benign regenerative nodules in Budd-Chiari syndrome and other vascular disorders of the liver: radiologic-pathologic and clinical correlation |journal=Radiographics |volume=22 |issue=4 |pages=847–62 |year=2002 |pmid=12110714 |doi=10.1148/radiographics.22.4.g02jl17847 |url=}}</ref><ref name="NewerlaSchaeffer2012">{{cite journal|last1=Newerla|first1=Caroline|last2=Schaeffer|first2=Fabienne|last3=Terracciano|first3=Luigi|last4=Hohmann|first4=Joachim|title=Multiple FNH-Like Lesions in a Patient with Chronic Budd-Chiari Syndrome: Gd-EOB-Enhanced MRI and BR1 CEUS Findings|journal=Case Reports in Radiology|volume=2012|year=2012|pages=1–5|issn=2090-6862|doi=10.1155/2012/685486}}</ref><ref name="pmid22618456">{{cite journal |vauthors=Yoneda N, Matsui O, Kitao A, Kita R, Kozaka K, Koda W, Kobayashi S, Gabata T, Ikeda H, Sato Y, Nakanuma Y |title=Hepatocyte transporter expression in FNH and FNH-like nodule: correlation with signal intensity on gadoxetic acid enhanced magnetic resonance images |journal=Jpn J Radiol |volume=30 |issue=6 |pages=499–508 |year=2012 |pmid=22618456 |doi=10.1007/s11604-012-0085-4 |url=}}</ref>
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*[[Gallbladder cancer]]
*[[Gallbladder cancer]]
*[[Hereditary hemorrhagic telangiectasia]]<ref name="MemeoStabile Ianora2004">{{cite journal|last1=Memeo|first1=M.|last2=Stabile Ianora|first2=A. A.|last3=Scardapane|first3=A.|last4=Buonamico|first4=P.|last5=Sabbà|first5=C.|last6=Angelelli|first6=G.|title=Hepatic involvement in hereditary hemorrhagic telangiectasia:|journal=Abdominal Imaging|volume=29|issue=2|year=2004|pages=211–220|issn=0942-8925|doi=10.1007/s00261-003-0101-3}}</ref><ref name="pmid18203937">{{cite journal |vauthors=Siddiki H, Doherty MG, Fletcher JG, Stanson AW, Vrtiska TJ, Hough DM, Fidler JL, McCollough CH, Swanson KL |title=Abdominal findings in hereditary hemorrhagic telangiectasia: pictorial essay on 2D and 3D findings with isotropic multiphase CT |journal=Radiographics |volume=28 |issue=1 |pages=171–84 |year=2008 |pmid=18203937 |doi=10.1148/rg.281075037 |url=}}</ref><ref name="pmid8816509">{{cite journal |vauthors=Oliver JH, Baron RL |title=Helical biphasic contrast-enhanced CT of the liver: technique, indications, interpretation, and pitfalls |journal=Radiology |volume=201 |issue=1 |pages=1–14 |year=1996 |pmid=8816509 |doi=10.1148/radiology.201.1.8816509 |url=}}</ref><ref name="pmid9169697">{{cite journal |vauthors=Yu JS, Kim KW, Sung KB, Lee JT, Yoo HS |title=Small arterial-portal venous shunts: a cause of pseudolesions at hepatic imaging |journal=Radiology |volume=203 |issue=3 |pages=737–42 |year=1997 |pmid=9169697 |doi=10.1148/radiology.203.3.9169697 |url=}}</ref><ref name="WuSaluja2006">{{cite journal|last1=Wu|first1=Jim S.|last2=Saluja|first2=Sanjay|last3=Garcia-Tsao|first3=Guadalupe|last4=Chong|first4=Alice|last5=Henderson|first5=Katherine J.|last6=White|first6=Robert I.|title=Liver Involvement in Hereditary Hemorrhagic Telangiectasia: CT and Clinical Findings Do Not Correlate in Symptomatic Patients|journal=American Journal of Roentgenology|volume=187|issue=4|year=2006|pages=W399–W405|issn=0361-803X|doi=10.2214/AJR.05.1068}}</ref>
*[[Hereditary hemorrhagic telangiectasia]]<ref name="MemeoStabile Ianora2004">{{cite journal|last1=Memeo|first1=M.|last2=Stabile Ianora|first2=A. A.|last3=Scardapane|first3=A.|last4=Buonamico|first4=P.|last5=Sabbà|first5=C.|last6=Angelelli|first6=G.|title=Hepatic involvement in hereditary hemorrhagic telangiectasia:|journal=Abdominal Imaging|volume=29|issue=2|year=2004|pages=211–220|issn=0942-8925|doi=10.1007/s00261-003-0101-3}}</ref><ref name="pmid18203937">{{cite journal |vauthors=Siddiki H, Doherty MG, Fletcher JG, Stanson AW, Vrtiska TJ, Hough DM, Fidler JL, McCollough CH, Swanson KL |title=Abdominal findings in hereditary hemorrhagic telangiectasia: pictorial essay on 2D and 3D findings with isotropic multiphase CT |journal=Radiographics |volume=28 |issue=1 |pages=171–84 |year=2008 |pmid=18203937 |doi=10.1148/rg.281075037 |url=}}</ref><ref name="pmid8816509">{{cite journal |vauthors=Oliver JH, Baron RL |title=Helical biphasic contrast-enhanced CT of the liver: technique, indications, interpretation, and pitfalls |journal=Radiology |volume=201 |issue=1 |pages=1–14 |year=1996 |pmid=8816509 |doi=10.1148/radiology.201.1.8816509 |url=}}</ref><ref name="pmid9169697">{{cite journal |vauthors=Yu JS, Kim KW, Sung KB, Lee JT, Yoo HS |title=Small arterial-portal venous shunts: a cause of pseudolesions at hepatic imaging |journal=Radiology |volume=203 |issue=3 |pages=737–42 |year=1997 |pmid=9169697 |doi=10.1148/radiology.203.3.9169697 |url=}}</ref><ref name="WuSaluja2006">{{cite journal|last1=Wu|first1=Jim S.|last2=Saluja|first2=Sanjay|last3=Garcia-Tsao|first3=Guadalupe|last4=Chong|first4=Alice|last5=Henderson|first5=Katherine J.|last6=White|first6=Robert I.|title=Liver Involvement in Hereditary Hemorrhagic Telangiectasia: CT and Clinical Findings Do Not Correlate in Symptomatic Patients|journal=American Journal of Roentgenology|volume=187|issue=4|year=2006|pages=W399–W405|issn=0361-803X|doi=10.2214/AJR.05.1068}}</ref>
*[[Inflammation|Inflammatory]] pseudotumors<ref name="ItaiMatsui1997">{{cite journal|last1=Itai|first1=Y|last2=Matsui|first2=O|title=Blood flow and liver imaging.|journal=Radiology|volume=202|issue=2|year=1997|pages=306–314|issn=0033-8419|doi=10.1148/radiology.202.2.9015047}}</ref><ref name="MathieuVasile1985"><nowiki>{{cite</nowiki></ref>&lt;/nowiki&gt;<ref name="MathieuVasile1985">{{cite journal|last1=Mathieu|first1=D|last2=Vasile|first2=N|last3=Dibie|first3=C|last4=Grenier|first4=P|title=Portal cavernoma: dynamic CT features and transient differences in hepatic attenuation.|journal=Radiology|volume=154|issue=3|year=1985|pages=743–748|issn=0033-8419|doi=10.1148/radiology.154.3.3881794}}</ref><ref name="pmid3881794">{{cite journal |vauthors=Mathieu D, Vasile N, Dibie C, Grenier P |title=Portal cavernoma: dynamic CT features and transient differences in hepatic attenuation |journal=Radiology |volume=154 |issue=3 |pages=743–8 |year=1985 |pmid=3881794 |doi=10.1148/radiology.154.3.3881794 |url=}}</ref><ref>Itai Y, Murata S, Saida Y, Minami M. Central zone and peripheral zone of the liver based on portal and hepatic arterial blood supply: imaging approach to deformity of cirrhotic liver. Jpn J Clin Radiol. 1994;39:1553–1559</ref>
*[[Inflammation|Inflammatory]] pseudotumors<ref name="ItaiMatsui1997">{{cite journal|last1=Itai|first1=Y|last2=Matsui|first2=O|title=Blood flow and liver imaging.|journal=Radiology|volume=202|issue=2|year=1997|pages=306–314|issn=0033-8419|doi=10.1148/radiology.202.2.9015047}}</ref><ref name="MathieuVasile1985"><nowiki>{{cite</nowiki></ref><ref name="pmid3881794">{{cite journal |vauthors=Mathieu D, Vasile N, Dibie C, Grenier P |title=Portal cavernoma: dynamic CT features and transient differences in hepatic attenuation |journal=Radiology |volume=154 |issue=3 |pages=743–8 |year=1985 |pmid=3881794 |doi=10.1148/radiology.154.3.3881794 |url=}}</ref><ref>Itai Y, Murata S, Saida Y, Minami M. Central zone and peripheral zone of the liver based on portal and hepatic arterial blood supply: imaging approach to deformity of cirrhotic liver. Jpn J Clin Radiol. 1994;39:1553–1559</ref>
*[[Hemangioma|Liver hemangioma]]<ref name="KimLee2011">{{cite journal|last1=Kim|first1=Tae Kyoung|last2=Lee|first2=Kyoung Ho|last3=Jang|first3=Hyun–Jung|last4=Haider|first4=Masoom A.|last5=Jacks|first5=Lindsay M.|last6=Menezes|first6=Ravi J.|last7=Park|first7=Seong Ho|last8=Yazdi|first8=Leyla|last9=Sherman|first9=Morris|last10=Khalili|first10=Korosh|title=Analysis of Gadobenate Dimeglumine–enhanced MR Findings for Characterizing Small (1–2-cm) Hepatic Nodules in Patients at High Risk for Hepatocellular Carcinoma|journal=Radiology|volume=259|issue=3|year=2011|pages=730–738|issn=0033-8419|doi=10.1148/radiol.11101549}}</ref><ref name="pmid11833870">{{cite journal |vauthors=Kim JH, Kim TK, Kim BS, Eun HW, Kim PN, Lee MG, Ha HK |title=Enhancement of hepatic hemangiomas with levovist on coded harmonic angiographic ultrasonography |journal=J Ultrasound Med |volume=21 |issue=2 |pages=141–8 |year=2002 |pmid=11833870 |doi= |url=}}</ref><ref name="BranniganBurns2004">{{cite journal|last1=Brannigan|first1=Margot|last2=Burns|first2=Peter N.|last3=Wilson|first3=Stephanie R.|title=Blood Flow Patterns in Focal Liver Lesions at Microbubble-enhanced US|journal=RadioGraphics|volume=24|issue=4|year=2004|pages=921–935|issn=0271-5333|doi=10.1148/rg.244035158}}</ref><ref name="pmid16641791">{{cite journal |vauthors=Kim TK, Jang HJ, Wilson SR |title=Benign liver masses: imaging with microbubble contrast agents |journal=Ultrasound Q |volume=22 |issue=1 |pages=31–9 |year=2006 |pmid=16641791 |doi= |url=}}</ref><ref name="JangKim2003">{{cite journal|last1=Jang|first1=Hyun-Jung|last2=Kim|first2=Tae Kyoung|last3=Lim|first3=Hyo Keun|last4=Park|first4=Sang Jae|last5=Sim|first5=Jung Suk|last6=Kim|first6=Hyae Young|last7=Lee|first7=Joo-Hyuk|title=Hepatic Hemangioma: Atypical Appearances on CT, MR Imaging, and Sonography|journal=American Journal of Roentgenology|volume=180|issue=1|year=2003|pages=135–141|issn=0361-803X|doi=10.2214/ajr.180.1.1800135}}</ref><ref>{{cite journal|doi=10.1102/1470-7330.2009.0015}}</ref><ref name="JangYu2009">{{cite journal|last1=Jang|first1=Hyun-Jung|last2=Yu|first2=Hojun|last3=Kim|first3=Tae Kyoung|title=Imaging of Focal Liver Lesions|journal=Seminars in Roentgenology|volume=44|issue=4|year=2009|pages=266–282|issn=0037198X|doi=10.1053/j.ro.2009.05.008}}</ref><ref name="JangYu2009">{{cite journal|last1=Jang|first1=Hyun-Jung|last2=Yu|first2=Hojun|last3=Kim|first3=Tae Kyoung|title=Imaging of Focal Liver Lesions|journal=Seminars in Roentgenology|volume=44|issue=4|year=2009|pages=266–282|issn=0037198X|doi=10.1053/j.ro.2009.05.008}}</ref><ref name="BhayanaKim2010">{{cite journal|last1=Bhayana|first1=Deepak|last2=Kim|first2=Tae Kyoung|last3=Jang|first3=Hyun-Jung|last4=Burns|first4=Peter N.|last5=Wilson|first5=Stephanie R.|title=Hypervascular Liver Masses on Contrast-Enhanced Ultrasound: The Importance of Washout|journal=American Journal of Roentgenology|volume=194|issue=4|year=2010|pages=977–983|issn=0361-803X|doi=10.2214/AJR.09.3375}}</ref><ref name="pmid21427331">{{cite journal |vauthors=Tamada T, Ito K, Yamamoto A, Sone T, Kanki A, Tanaka F, Higashi H |title=Hepatic hemangiomas: evaluation of enhancement patterns at dynamic MRI with gadoxetate disodium |journal=AJR Am J Roentgenol |volume=196 |issue=4 |pages=824–30 |year=2011 |pmid=21427331 |doi=10.2214/AJR.10.5113 |url=}}</ref><ref name="Heiken2007">{{cite journal|last1=Heiken|first1=Jay P.|title=Distinguishing benign from malignant liver tumours|journal=Cancer Imaging|volume=7|issue=Special Issue A|year=2007|pages=S1–S14|issn=1470-7330|doi=10.1102/1470-7330.2007.9084}}</ref><ref name="AlturkistanyJang2011">{{cite journal|last1=Alturkistany|first1=Samira|last2=Jang|first2=Hyun-Jung|last3=Yu|first3=Hojun|last4=Lee|first4=Kyoung Ho|last5=Kim|first5=Tae Kyoung|title=Fading hepatic hemangiomas on multiphasic CT|journal=Abdominal Radiology|volume=37|issue=5|year=2011|pages=775–780|issn=2366-004X|doi=10.1007/s00261-011-9826-6}}</ref>
*[[Hemangioma|Liver hemangioma]]<ref name="KimLee2011">{{cite journal|last1=Kim|first1=Tae Kyoung|last2=Lee|first2=Kyoung Ho|last3=Jang|first3=Hyun–Jung|last4=Haider|first4=Masoom A.|last5=Jacks|first5=Lindsay M.|last6=Menezes|first6=Ravi J.|last7=Park|first7=Seong Ho|last8=Yazdi|first8=Leyla|last9=Sherman|first9=Morris|last10=Khalili|first10=Korosh|title=Analysis of Gadobenate Dimeglumine–enhanced MR Findings for Characterizing Small (1–2-cm) Hepatic Nodules in Patients at High Risk for Hepatocellular Carcinoma|journal=Radiology|volume=259|issue=3|year=2011|pages=730–738|issn=0033-8419|doi=10.1148/radiol.11101549}}</ref><ref name="pmid11833870">{{cite journal |vauthors=Kim JH, Kim TK, Kim BS, Eun HW, Kim PN, Lee MG, Ha HK |title=Enhancement of hepatic hemangiomas with levovist on coded harmonic angiographic ultrasonography |journal=J Ultrasound Med |volume=21 |issue=2 |pages=141–8 |year=2002 |pmid=11833870 |doi= |url=}}</ref><ref name="BranniganBurns2004">{{cite journal|last1=Brannigan|first1=Margot|last2=Burns|first2=Peter N.|last3=Wilson|first3=Stephanie R.|title=Blood Flow Patterns in Focal Liver Lesions at Microbubble-enhanced US|journal=RadioGraphics|volume=24|issue=4|year=2004|pages=921–935|issn=0271-5333|doi=10.1148/rg.244035158}}</ref><ref name="pmid16641791">{{cite journal |vauthors=Kim TK, Jang HJ, Wilson SR |title=Benign liver masses: imaging with microbubble contrast agents |journal=Ultrasound Q |volume=22 |issue=1 |pages=31–9 |year=2006 |pmid=16641791 |doi= |url=}}</ref><ref name="JangKim2003">{{cite journal|last1=Jang|first1=Hyun-Jung|last2=Kim|first2=Tae Kyoung|last3=Lim|first3=Hyo Keun|last4=Park|first4=Sang Jae|last5=Sim|first5=Jung Suk|last6=Kim|first6=Hyae Young|last7=Lee|first7=Joo-Hyuk|title=Hepatic Hemangioma: Atypical Appearances on CT, MR Imaging, and Sonography|journal=American Journal of Roentgenology|volume=180|issue=1|year=2003|pages=135–141|issn=0361-803X|doi=10.2214/ajr.180.1.1800135}}</ref><ref>{{cite journal|doi=10.1102/1470-7330.2009.0015}}</ref><ref name="JangYu2009">{{cite journal|last1=Jang|first1=Hyun-Jung|last2=Yu|first2=Hojun|last3=Kim|first3=Tae Kyoung|title=Imaging of Focal Liver Lesions|journal=Seminars in Roentgenology|volume=44|issue=4|year=2009|pages=266–282|issn=0037198X|doi=10.1053/j.ro.2009.05.008}}</ref><ref name="JangYu2009">{{cite journal|last1=Jang|first1=Hyun-Jung|last2=Yu|first2=Hojun|last3=Kim|first3=Tae Kyoung|title=Imaging of Focal Liver Lesions|journal=Seminars in Roentgenology|volume=44|issue=4|year=2009|pages=266–282|issn=0037198X|doi=10.1053/j.ro.2009.05.008}}</ref><ref name="BhayanaKim2010">{{cite journal|last1=Bhayana|first1=Deepak|last2=Kim|first2=Tae Kyoung|last3=Jang|first3=Hyun-Jung|last4=Burns|first4=Peter N.|last5=Wilson|first5=Stephanie R.|title=Hypervascular Liver Masses on Contrast-Enhanced Ultrasound: The Importance of Washout|journal=American Journal of Roentgenology|volume=194|issue=4|year=2010|pages=977–983|issn=0361-803X|doi=10.2214/AJR.09.3375}}</ref><ref name="pmid21427331">{{cite journal |vauthors=Tamada T, Ito K, Yamamoto A, Sone T, Kanki A, Tanaka F, Higashi H |title=Hepatic hemangiomas: evaluation of enhancement patterns at dynamic MRI with gadoxetate disodium |journal=AJR Am J Roentgenol |volume=196 |issue=4 |pages=824–30 |year=2011 |pmid=21427331 |doi=10.2214/AJR.10.5113 |url=}}</ref><ref name="Heiken2007">{{cite journal|last1=Heiken|first1=Jay P.|title=Distinguishing benign from malignant liver tumours|journal=Cancer Imaging|volume=7|issue=Special Issue A|year=2007|pages=S1–S14|issn=1470-7330|doi=10.1102/1470-7330.2007.9084}}</ref><ref name="AlturkistanyJang2011">{{cite journal|last1=Alturkistany|first1=Samira|last2=Jang|first2=Hyun-Jung|last3=Yu|first3=Hojun|last4=Lee|first4=Kyoung Ho|last5=Kim|first5=Tae Kyoung|title=Fading hepatic hemangiomas on multiphasic CT|journal=Abdominal Radiology|volume=37|issue=5|year=2011|pages=775–780|issn=2366-004X|doi=10.1007/s00261-011-9826-6}}</ref>
*[[Hepatoblastoma]] in children
*[[Hepatoblastoma]] in children
Line 35: Line 35:
<small>
<small>
{| class="wikitable" style="border: 0px; font-size: 90%; margin: 5px;" align="center"
{| class="wikitable" style="border: 0px; font-size: 90%; margin: 5px;" align="center"
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Disease
! style="background:#4479BA; color: #FFFFFF;" align="center" rowspan="3" |Disease
| colspan="13" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Clinical manifestations'''
| style="background:#4479BA; color: #FFFFFF;" colspan="13" align="center" rowspan="1" |'''Clinical manifestations'''
! colspan="2" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" |Diagnosis
! style="background:#4479BA; color: #FFFFFF;" colspan="2" align="center" rowspan="2" |Diagnosis
! rowspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" |Comments
! style="background:#4479BA; color: #FFFFFF;" align="center" rowspan="3" |Comments
|-
|-
| colspan="9" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" |'''Symptoms'''
| style="background:#4479BA; color: #FFFFFF;" colspan="9" align="center" rowspan="1" |'''Symptoms'''
! colspan="4" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Signs
! style="background:#4479BA; color: #FFFFFF;" colspan="4" align="center" rowspan="1" | Signs
|-
|-
! style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal Pain
! style="background:#4479BA; color: #FFFFFF;" align="center" |Abdominal Pain
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Fever  
! style="background:#4479BA; color: #FFFFFF;" colspan="1" align="center" rowspan="1" | Fever  
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rigors and chills
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rigors and chills
! style="background:#4479BA; color: #FFFFFF;" align="center" |Nausea or vomiting
! style="background:#4479BA; color: #FFFFFF;" align="center" |Nausea or vomiting
Line 54: Line 54:
! style="background:#4479BA; color: #FFFFFF;" align="center" |Hypo-
! style="background:#4479BA; color: #FFFFFF;" align="center" |Hypo-
tension
tension
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Guarding
! style="background:#4479BA; color: #FFFFFF;" colspan="1" align="center" rowspan="1" | Guarding
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rebound Tenderness
! style="background:#4479BA; color: #FFFFFF;" align="center" |Rebound Tenderness
! style="background:#4479BA; color: #FFFFFF;" align="center" |Bowel sounds
! style="background:#4479BA; color: #FFFFFF;" align="center" |Bowel sounds
! colspan="1" rowspan="1" style="background:#4479BA; color: #FFFFFF;" align="center" | Lab Findings
! style="background:#4479BA; color: #FFFFFF;" colspan="1" align="center" rowspan="1" | Lab Findings
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging
! style="background:#4479BA; color: #FFFFFF;" align="center" |Imaging
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Hepatocellular carcinoma]]/Metastasis
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''[[Hepatocellular carcinoma]]/[[Metastasis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |RUQ
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −  
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Normal
* Normal
* Hyperactive if obstruction present
* Hyperactive if obstruction present
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* High levels of [[Alpha-fetoprotein|AFP]] in serum
* High levels of [[Alpha-fetoprotein|AFP]] in serum
* Abnormal [[Liver function test|liver function tests]]
* Abnormal [[Liver function test|liver function tests]]
*[[Thrombocytopenia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* US
* [[Ultrasound|US]]
* CT
* [[Computed tomography|CT]]
* Liver biopsy
* [[MRI]]
* [[Liver biopsy]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
Other symptoms:
Other symptoms:
Line 91: Line 93:
* [[Asterixis]]
* [[Asterixis]]
|-
|-
| colspan="1" rowspan="1" style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cholangiocarcinoma]]
| style="padding: 5px 5px; background: #DCDCDC;" colspan="1" align="center" rowspan="1" |[[Cholangiocarcinoma]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Epigastric]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Elevated [[CA-19-9|CA 19-9]]
* Increased [[amylase]] / [[lipase]]
* Increased [[amylase]] / [[lipase]]
* Increased stool fat content
* Increased [[Steatorrhea|stool fat]] content
* Pancreatic function test
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |CT scan
*[[Contrast-enhanced ultrasound]]
* Calcification
*[[Computed tomography|CT scan]]
* Pseudocyst  
**[[Calcification]]
* Dilation of main pancreatic duct
**[[Pseudocyst]]
**Dilation of main pancreatic duct
*[[Magnetic resonance imaging|MRI]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Predisposes to pancreatic cancer
* Predisposes to pancreatic cancer
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pancreatic carcinoma]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Pancreatic carcinoma]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[Epigastric]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Mid[[Epigastric]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |−
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* ↑ [[Alkaline phosphatase]]
* ↑ [[Alkaline phosphatase]]
* ↑ [[Bilirubin|serum bilirubin]]
* ↑ [[Bilirubin|serum bilirubin]]
* ↑ [[gamma-glutamyl transpeptidase]]
* ↑ [[gamma-glutamyl transpeptidase]]
* ↑ [[CA 19-9]] 
* ↑ [[CA-19-9|CA 19-9]]  
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Computed tomography|MDCT]] with  [[Positron emission tomography|PET]]/[[Computed tomography|CT]]
* [[Computed tomography|MDCT]] with   [[Positron emission tomography|PET]]/[[Computed tomography|CT]]
* MRI
* MRI
* [[Endoscopic ultrasound|EUS]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
[[Skin]] manifestations may include:
[[Skin]] manifestations may include:
* [[Bullous pemphigoid]]
* [[Bullous pemphigoid]]
* [[Mucous membrane pemphigoid|Cicatricial pemphigoid]]
* [[Mucous membrane pemphigoid|Cicatricial pemphigoid]]
* [[Thrombophlebitis|Migratory superficial thrombophlebitis]] (classic [[Trousseau's syndrome]])
* [[Thrombophlebitis|Migratory superficial thrombophlebitis]] (classic [[Trousseau's syndrome]])
* [[Panniculitis|Pancreatic panniculitis]]
* [[Panniculitis|Pancreatic panniculitis]]
|-
|-
Line 151: Line 157:
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal or hyperactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal  
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Anti-neutrophil cytoplasmic antibody]] ([[P-ANCA]]) in [[Ulcerative colitis]]
* Normal Liver function tests
* [[Anti saccharomyces cerevisiae antibodies]] (ASCA) in [[Crohn's disease]]
* Normal AFP
*Minor elevations of
**[[Aspartate]]  
**[[Alanine aminotransferase]]
**[[Alkaline phosphatase]]
**[[Gamma glutamyl transpeptidase]]  
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[String sign]] on [[abdominal x-ray]] in [[Crohn's disease]]
* Us
* Multiphasic [[helical CT scan]]  
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
Extra intestinal findings:
* Open [[biopsy]] if diagnosis can not be established
* [[Uveitis]]
* [[Arthritis]]
|-
|-
! style="background:#4479BA; color: #FFFFFF;" align="center" |Disease
! style="background:#4479BA; color: #FFFFFF;" align="center" |Disease
Line 189: Line 199:
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gallbladder cancer]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Gallbladder cancer]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Diffuse
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Mid[[Epigastric|epigastric]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" | Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* ↑ [[Alkaline phosphatase]]
* ↑ [[CA-19-9|CA 19-9]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Ultrasonography|US]]
* CT
* MRI
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Thrombocytopenia]]
* [[Hypoalbuminemia]]
* [[Small intestinal]] [[biopsy]] for [[Tropheryma whipplei]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |[[Whipple's disease other diagnostic studies|Endoscopy]] is used to confirm diagnosis.
Images used to find complications
*[[Whipple's disease x ray|Chest and joint x-ray]]
*[[Whipple's disease CT|CT]]
*[[Whipple's disease MRI|MRI]]
*[[Whipple's disease ultrasound|Echocardiography]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Extra intestinal findings:
* [[Uveitis]]
* [[Endocarditis]]
* [[Encephalitis]]
* [[Dementia]]
* [[Hepatosplenomegaly]]
* [[Arthritis]]
* [[Ascites]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Liver hemangioma]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Liver hemangioma]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Intermittent [[RUQ]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive in Hep A and E
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive in fulminant hepatitis
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>−</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | Positive in acute
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Abnormal LFTs
* Abnormal LFTs
* Viral serology
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* US
* US
* [[Single photon emission computed tomography|Single-photon emission computerized tomography(SPECT]])
* MRI
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* Hep A and E have fecal-oral route of transmission
* US will reveal hypoechoic [[lesions]]
* Hep B and C transmits via blood transfusion and sexual contact.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Liver abscess]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Liver abscess]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |RUQ
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |RUQ
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal or hypoactive
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* CBC
* Hypoalbuminemia
* Blood cultures
* Abnormal [[Liver function test|liver function tests]]
* Abnormal [[Liver function test|liver function tests]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* US
* US
Line 268: Line 267:
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cirrhosis|Cirrhosis]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Cirrhosis|Cirrhosis]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]+Bloating
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Hypoalbuminemia]]
* [[Hypoalbuminemia]]
Line 293: Line 292:
* Stigmata of liver disease
* Stigmata of liver disease
* Cruveilhier- Baumgarten murmur
* Cruveilhier- Baumgarten murmur
|-style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|- style="padding: 5px 5px; background: #F5F5F5;" align="left" |
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Inflammatory lesions]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Inflammatory lesions
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |[[RUQ]]
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | ±
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>−</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |<nowiki>+</nowiki>
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | +
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | −
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |N
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |Normal
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |
* [[Hypoalbuminemia]]
* [[Hypoalbuminemia]]
Line 316: Line 315:
* [[Thrombocytopenia]]
* [[Thrombocytopenia]]
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |US
| style="padding: 5px 5px; background: #F5F5F5;" align="left" |US
* Nodular, shrunken liver
* Nodular,shrunken or coarse liver
* [[Ascites]]
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* Stigmata of liver disease
* Stigmata of liver disease
* Cruveilhier- Baumgarten murmur
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[[Category:Disease]]
[[Category:Disease]]
[[Category:Medicine]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Types of cancer]]
[[Category:Types of cancer]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Hepatology]]
[[Category:Hepatology]]
[[Category:Gastroenterology]]
[[Category:Surgery]]
[[Category:Surgery]]
[[Category:Emergency medicine]]

Latest revision as of 22:08, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2]

Overview

Hepatocellular carcinoma must be differentiated from other diseases that cause abdominal pain, jaundice, and weight loss, such as liver cirrhosis and pancreatitis.

Differentiating Hepatocellular Carcinoma from other Diseases

Hepatocellular carcinoma must be differentiated from the following diseases:[1][2][3][4][5][6][7][8][9][10]

Abbreviations: RUQ= Right upper quadrant of the abdomen, LUQ= Left upper quadrant, LLQ= Left lower quadrant, RLQ= Right lower quadrant, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, IV= Intravenous, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CXR= Chest X ray, IgA= Immunoglobulin A, IgG= Immunoglobulin G, IgM= Immunoglobulin M, CT= Computed tomography, PMN= Polymorphonuclear cells, ESR= Erythrocyte sedimentation rate, CRP= C-reactive protein, TS= Transferrin saturation, SF= Serum Ferritin, SMA= Superior mesenteric artery, SMV= Superior mesenteric vein, ECG= Electrocardiogram

Disease Clinical manifestations Diagnosis Comments
Symptoms Signs
Abdominal Pain Fever Rigors and chills Nausea or vomiting Jaundice Constipation Diarrhea Weight loss GI bleeding Hypo-

tension

Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging
Hepatocellular carcinoma/Metastasis RUQ + − + + + + + + + − +
  • Normal
  • Hyperactive if obstruction present

Other symptoms:

Cholangiocarcinoma RUQ + − + + − − + − − − + Normal
  • Predisposes to pancreatic cancer
Pancreatic carcinoma MidEpigastric − − + + + − + − − − + Normal

Skin manifestations may include:

Focal nodular hyperplasia Diffuse ± − − ± − − + + − − − Normal
  • Open biopsy if diagnosis can not be established
Disease Abdominal Pain Fever Rigors and chills Nausea or vomiting Jaundice Constipation Diarrhea Weight loss GI bleeding Hypo-

tension

Guarding Rebound Tenderness Bowel sounds Lab Findings Imaging Comments
Gallbladder cancer Midepigastric − − + + − + + − − − − Normal
Liver hemangioma Intermittent RUQ − − + + − − − − − − − Normal
  • Abnormal LFTs
Liver abscess RUQ + − + + − − + − − − − Normal
  • US
  • CT
Cirrhosis RUQ+Bloating + − + + − − + − − − − Normal US
  • Stigmata of liver disease
  • Cruveilhier- Baumgarten murmur
Inflammatory lesions RUQ ± − + + − − − − − − − Normal US
  • Nodular,shrunken or coarse liver
  • Stigmata of liver disease

References

  1. ↑ Kim TK, Lee E, Jang HJ (2015). "Imaging findings of mimickers of hepatocellular carcinoma". Clin Mol Hepatol. 21 (4): 326–43. doi:10.3350/cmh.2015.21.4.326. PMC 4712159. PMID 26770920.
  2. ↑ Ferrell, Linda (2000). "Liver Pathology: Cirrhosis, Hepatitis and Primary Liver Tumors. Update and Diagnostic Problems". Modern Pathology. 13 (6): 679–704. doi:10.1038/modpathol.3880119. ISSN 0893-3952.
  3. ↑ Kim, Tae Kyoung; Lee, Eunchae; Jang, Hyun-Jung (2015). "Imaging findings of mimickers of hepatocellular carcinoma". Clinical and Molecular Hepatology. 21 (4): 326. doi:10.3350/cmh.2015.21.4.326. ISSN 2287-2728.
  4. ↑ Doo, Kyung Won; Lee, Chang Hee; Choi, Jae Woong; Lee, Jongmee; Kim, Kyeong Ah; Park, Cheol Min (2009). ""Pseudo Washout" Sign in High-Flow Hepatic Hemangioma on Gadoxetic Acid Contrast-Enhanced MRI Mimicking Hypervascular Tumor". American Journal of Roentgenology. 193 (6): W490–W496. doi:10.2214/AJR.08.1732. ISSN 0361-803X.
  5. ↑ Zech CJ, Herrmann KA, Reiser MF, Schoenberg SO (2007). "MR imaging in patients with suspected liver metastases: value of liver-specific contrast agent Gd-EOB-DTPA". Magn Reson Med Sci. 6 (1): 43–52. PMID 17510541.
  6. ↑ Cheng, H C; Tsai, S H; Chiang, J H; Chang, C Y (1995). "Hyalinized liver hemangioma mimicking malignant tumor at MR imaging". American Journal of Roentgenology. 165 (4): 1016–1017. doi:10.2214/ajr.165.4.7676959. ISSN 0361-803X.
  7. ↑ Haratake J, Horie A, Nagafuchi Y (1992). "Hyalinized hemangioma of the liver". Am. J. Gastroenterol. 87 (2): 234–6. PMID 1370873.
  8. ↑ Takayasu, K; Moriyama, N; Shima, Y; Muramatsu, Y; Yamada, T; Makuuchi, M; Yamasaki, S; Hirohashi, S (1986). "Atypical radiographic findings in hepatic cavernous hemangioma: correlation with histologic features". American Journal of Roentgenology. 146 (6): 1149–1153. doi:10.2214/ajr.146.6.1149. ISSN 0361-803X.
  9. ↑ Yamashita Y, Shimada M, Taguchi K, Gion T, Hasegawa H, Utsunomiya T, Hamatsu T, Matsumata T, Sugimachi K (2000). "Hepatic sclerosing hemangioma mimicking a metastatic liver tumor: report of a case". Surg. Today. 30 (9): 849–52. PMID 11039718.
  10. ↑ Kim, Tae Kyoung; Lee, Eunchae; Jang, Hyun-Jung (2015). "Imaging findings of mimickers of hepatocellular carcinoma". Clinical and Molecular Hepatology. 21 (4): 326. doi:10.3350/cmh.2015.21.4.326. ISSN 2287-2728.
  11. ↑ Lee, So Jung; Kim, So Yeon; Kim, Kyoung Won; Shin, Yong Moon; Kim, Hyoung Jung; Lee, Jong Seok; Kim, Sun A (2012). "Hepatic angiomyolipoma with minimal fat, mimicking hepatocellular carcinoma". Clinical and Molecular Hepatology. 18 (3): 330. doi:10.3350/cmh.2012.18.3.330. ISSN 2287-2728.
  12. ↑ Kim R, Lee JM, Joo I, Lee DH, Woo S, Han JK, Choi BI (2015). "Differentiation of lipid poor angiomyolipoma from hepatocellular carcinoma on gadoxetic acid-enhanced liver MR imaging". Abdom Imaging. 40 (3): 531–41. doi:10.1007/s00261-014-0244-4. PMID 25231411.
  13. ↑ Jeon TY, Kim SH, Lim HK, Lee WJ (2010). "Assessment of triple-phase CT findings for the differentiation of fat-deficient hepatic angiomyolipoma from hepatocellular carcinoma in non-cirrhotic liver". Eur J Radiol. 73 (3): 601–6. doi:10.1016/j.ejrad.2009.01.010. PMID 19200676.
  14. ↑ Kim, T K; Choi, B I; Han, J K; Jang, H J; Cho, S G; Han, M C (1997). "Peripheral cholangiocarcinoma of the liver: two-phase spiral CT findings". Radiology. 204 (2): 539–543. doi:10.1148/radiology.204.2.9240550. ISSN 0033-8419.
  15. ↑ Choi BI, Kim TK, Han JK (1998). "MRI of clonorchiasis and cholangiocarcinoma". J Magn Reson Imaging. 8 (2): 359–66. PMID 9562062.
  16. ↑ Guo, Le-Hang; Xu, Hui-Xiong (2015). "Contrast-Enhanced Ultrasound in the Diagnosis of Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma: Controversy over the ASSLD Guideline". BioMed Research International. 2015: 1–5. doi:10.1155/2015/349172. ISSN 2314-6133.
  17. ↑ Wilson, Stephanie R.; Kim, Tae Kyoung; Jang, Hyun-Jung; Burns, Peter N. (2007). "Enhancement Patterns of Focal Liver Masses: Discordance Between Contrast-Enhanced Sonography and Contrast-Enhanced CT and MRI". American Journal of Roentgenology. 189 (1): W7–W12. doi:10.2214/AJR.06.1060. ISSN 0361-803X.
  18. ↑ Ohtomo K, Baron RL, Dodd GD, Federle MP, Miller WJ, Campbell WL, Confer SR, Weber KM (1993). "Confluent hepatic fibrosis in advanced cirrhosis: appearance at CT". Radiology. 188 (1): 31–5. doi:10.1148/radiology.188.1.8511316. PMID 8511316.
  19. ↑ Hussain, Hero K.; Syed, Ibrahim; Nghiem, Hanh V.; Johnson, Timothy D.; Carlos, Ruth C.; Weadock, William J.; Francis, Isaac R. (2004). "T2-weighted MR Imaging in the Assessment of Cirrhotic Liver". Radiology. 230 (3): 637–644. doi:10.1148/radiol.2303020921. ISSN 0033-8419.
  20. ↑ Ohtomo K, Baron RL, Dodd GD, Federle MP, Ohtomo Y, Confer SR (1993). "Confluent hepatic fibrosis in advanced cirrhosis: evaluation with MR imaging". Radiology. 189 (3): 871–4. doi:10.1148/radiology.189.3.8234718. PMID 8234718.
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  22. ↑ Kelekis NL, Makri E, Vassiou A, Patsiaoura K, Spiridakis M, Dalekos GN (2004). "Confluent hepatic fibrosis as the presenting imaging sign in nonadvanced alcoholic cirrhosis". Clin Imaging. 28 (2): 124–7. doi:10.1016/S0899-7071(03)00243-2. PMID 15050225.
  23. ↑ Ooi CG, Chan KL, Peh WC, Saing H, Ngan H (1999). "Confluent hepatic fibrosis in monozygotic twins". Pediatr Radiol. 29 (1): 53–5. doi:10.1007/s002470050534. PMID 9880618.
  24. ↑ Park YS, Lee CH, Kim BH, Lee J, Choi JW, Kim KA, Ahn JH, Park CM (2013). "Using Gd-EOB-DTPA-enhanced 3-T MRI for the differentiation of infiltrative hepatocellular carcinoma and focal confluent fibrosis in liver cirrhosis". Magn Reson Imaging. 31 (7): 1137–42. doi:10.1016/j.mri.2013.01.011. PMID 23688409.
  25. ↑ Brancatelli G, Federle MP, Grazioli L, Golfieri R, Lencioni R (2002). "Large regenerative nodules in Budd-Chiari syndrome and other vascular disorders of the liver: CT and MR imaging findings with clinicopathologic correlation". AJR Am J Roentgenol. 178 (4): 877–83. doi:10.2214/ajr.178.4.1780877. PMID 11906867.
  26. ↑ Brancatelli G, Federle MP, Grazioli L, Golfieri R, Lencioni R (2002). "Benign regenerative nodules in Budd-Chiari syndrome and other vascular disorders of the liver: radiologic-pathologic and clinical correlation". Radiographics. 22 (4): 847–62. doi:10.1148/radiographics.22.4.g02jl17847. PMID 12110714.
  27. ↑ Newerla, Caroline; Schaeffer, Fabienne; Terracciano, Luigi; Hohmann, Joachim (2012). "Multiple FNH-Like Lesions in a Patient with Chronic Budd-Chiari Syndrome: Gd-EOB-Enhanced MRI and BR1 CEUS Findings". Case Reports in Radiology. 2012: 1–5. doi:10.1155/2012/685486. ISSN 2090-6862.
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  29. ↑ Matsui, O; Kadoya, M; Takahashi, S; Yoshikawa, J; Gabata, T; Takashima, T; Kitagawa, K (1995). "Focal sparing of segment IV in fatty livers shown by sonography and CT: correlation with aberrant gastric venous drainage". American Journal of Roentgenology. 164 (5): 1137–1140. doi:10.2214/ajr.164.5.7717220. ISSN 0361-803X.
  30. ↑ Itai Y, Matsui O (1999). "'Nonportal' splanchnic venous supply to the liver: abnormal findings on CT, US and MRI". Eur Radiol. 9 (2): 237–43. doi:10.1007/s003300050661. PMID 10101644.
  31. [[#cite_ref-NicolauBr�2004_31-0|↑]] Nicolau, C.; Br�, C. (2004). "Focal liver lesions: evaluation with contrast-enhanced ultrasonography". Abdominal Imaging. 29 (3). doi:10.1007/s00261-003-0117-8. ISSN 0942-8925. replacement character in |last2= at position 3 (help)
  32. ↑ Hamer OW, Aguirre DA, Casola G, Lavine JE, Woenckhaus M, Sirlin CB (2006). "Fatty liver: imaging patterns and pitfalls". Radiographics. 26 (6): 1637–53. doi:10.1148/rg.266065004. PMID 17102041.
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  34. ↑ Memeo, M.; Stabile Ianora, A. A.; Scardapane, A.; Buonamico, P.; Sabbà, C.; Angelelli, G. (2004). "Hepatic involvement in hereditary hemorrhagic telangiectasia:". Abdominal Imaging. 29 (2): 211–220. doi:10.1007/s00261-003-0101-3. ISSN 0942-8925.
  35. ↑ Siddiki H, Doherty MG, Fletcher JG, Stanson AW, Vrtiska TJ, Hough DM, Fidler JL, McCollough CH, Swanson KL (2008). "Abdominal findings in hereditary hemorrhagic telangiectasia: pictorial essay on 2D and 3D findings with isotropic multiphase CT". Radiographics. 28 (1): 171–84. doi:10.1148/rg.281075037. PMID 18203937.
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  38. ↑ Wu, Jim S.; Saluja, Sanjay; Garcia-Tsao, Guadalupe; Chong, Alice; Henderson, Katherine J.; White, Robert I. (2006). "Liver Involvement in Hereditary Hemorrhagic Telangiectasia: CT and Clinical Findings Do Not Correlate in Symptomatic Patients". American Journal of Roentgenology. 187 (4): W399–W405. doi:10.2214/AJR.05.1068. ISSN 0361-803X.
  39. ↑ Itai, Y; Matsui, O (1997). "Blood flow and liver imaging". Radiology. 202 (2): 306–314. doi:10.1148/radiology.202.2.9015047. ISSN 0033-8419.
  40. ↑ {{cite
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  43. ↑ Kim, Tae Kyoung; Lee, Kyoung Ho; Jang, Hyun–Jung; Haider, Masoom A.; Jacks, Lindsay M.; Menezes, Ravi J.; Park, Seong Ho; Yazdi, Leyla; Sherman, Morris; Khalili, Korosh (2011). "Analysis of Gadobenate Dimeglumine–enhanced MR Findings for Characterizing Small (1–2-cm) Hepatic Nodules in Patients at High Risk for Hepatocellular Carcinoma". Radiology. 259 (3): 730–738. doi:10.1148/radiol.11101549. ISSN 0033-8419.
  44. ↑ Kim JH, Kim TK, Kim BS, Eun HW, Kim PN, Lee MG, Ha HK (2002). "Enhancement of hepatic hemangiomas with levovist on coded harmonic angiographic ultrasonography". J Ultrasound Med. 21 (2): 141–8. PMID 11833870.
  45. ↑ Brannigan, Margot; Burns, Peter N.; Wilson, Stephanie R. (2004). "Blood Flow Patterns in Focal Liver Lesions at Microbubble-enhanced US". RadioGraphics. 24 (4): 921–935. doi:10.1148/rg.244035158. ISSN 0271-5333.
  46. ↑ 46.0 46.1 Kim TK, Jang HJ, Wilson SR (2006). "Benign liver masses: imaging with microbubble contrast agents". Ultrasound Q. 22 (1): 31–9. PMID 16641791.
  47. ↑ Jang, Hyun-Jung; Kim, Tae Kyoung; Lim, Hyo Keun; Park, Sang Jae; Sim, Jung Suk; Kim, Hyae Young; Lee, Joo-Hyuk (2003). "Hepatic Hemangioma: Atypical Appearances on CT, MR Imaging, and Sonography". American Journal of Roentgenology. 180 (1): 135–141. doi:10.2214/ajr.180.1.1800135. ISSN 0361-803X.
  48. ↑ . doi:10.1102/1470-7330.2009.0015. Missing or empty |title= (help)
  49. ↑ 49.0 49.1 Jang, Hyun-Jung; Yu, Hojun; Kim, Tae Kyoung (2009). "Imaging of Focal Liver Lesions". Seminars in Roentgenology. 44 (4): 266–282. doi:10.1053/j.ro.2009.05.008. ISSN 0037-198X.
  50. ↑ Bhayana, Deepak; Kim, Tae Kyoung; Jang, Hyun-Jung; Burns, Peter N.; Wilson, Stephanie R. (2010). "Hypervascular Liver Masses on Contrast-Enhanced Ultrasound: The Importance of Washout". American Journal of Roentgenology. 194 (4): 977–983. doi:10.2214/AJR.09.3375. ISSN 0361-803X.
  51. ↑ Tamada T, Ito K, Yamamoto A, Sone T, Kanki A, Tanaka F, Higashi H (2011). "Hepatic hemangiomas: evaluation of enhancement patterns at dynamic MRI with gadoxetate disodium". AJR Am J Roentgenol. 196 (4): 824–30. doi:10.2214/AJR.10.5113. PMID 21427331.
  52. ↑ Heiken, Jay P. (2007). "Distinguishing benign from malignant liver tumours". Cancer Imaging. 7 (Special Issue A): S1–S14. doi:10.1102/1470-7330.2007.9084. ISSN 1470-7330.
  53. ↑ Alturkistany, Samira; Jang, Hyun-Jung; Yu, Hojun; Lee, Kyoung Ho; Kim, Tae Kyoung (2011). "Fading hepatic hemangiomas on multiphasic CT". Abdominal Radiology. 37 (5): 775–780. doi:10.1007/s00261-011-9826-6. ISSN 2366-004X.
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  55. ↑ Kim, Kyoung Won; Choi, Byung Ihn; Park, Seong Ho; Kim, Ah Young; Koh, Young Hwan; Lee, Hyun Ju; Han, Joon Koo (2004). "Pyogenic hepatic abscesses: distinctive features from hypovascular hepatic malignancies on contrast-enhanced ultrasound with SH U 508A; early experience". Ultrasound in Medicine & Biology. 30 (6): 725–733. doi:10.1016/j.ultrasmedbio.2004.03.006. ISSN 0301-5629.
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  58. ↑ Gollapudi P, Chejfec G, Zarling EJ (1992). "Spontaneous regression of hepatic pseudotumor". Am. J. Gastroenterol. 87 (2): 214–7. PMID 1734701.
  59. ↑ Yoon KH, Ha HK, Lee JS, Suh JH, Kim MH, Kim PN, Lee MG, Yun KJ, Choi SC, Nah YH, Kim CG, Won JJ, Auh YH (1999). "Inflammatory pseudotumor of the liver in patients with recurrent pyogenic cholangitis: CT-histopathologic correlation". Radiology. 211 (2): 373–9. doi:10.1148/radiology.211.2.r99ma36373. PMID 10228516.
  60. ↑ CHEDID, Marcio F.; KRUEL, Cleber R. P.; PINTO, Marcelo A.; GREZZANA-FILHO, Tomaz J. M.; LEIPNITZ, Ian; KRUEL, Cleber D. P.; SCAFFARO, Leandro A.; CHEDID, Aljamir D. (2017). "HEPATOCELLULAR CARCINOMA: DIAGNOSIS AND OPERATIVE MANAGEMENT". ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo). 30 (4): 272–278. doi:10.1590/0102-6720201700040011. ISSN 2317-6326.


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