Hepatocellular carcinoma mimicking liver abscess

Abstract

Hepatocellular carcinoma (HCC) is the most frequent primary malignancy of the liver which can be presented in many different clinical situations. Beyond the well-known risk factors it can also be seen without any of them. We present the successful management of a patient with HCC mimicking a liver abscess. A 20-year-old woman admitted to the emergency department with high fever, abdominal pain, and elevated white blood count, c-reactive protein level. Ultrasonogarphy and computed tomography of the abdomen revealed a huge heterogeneous mass in the left liver containing air bubbles inside. Liver transaminases were elevated. The further radiologic evaluation through magnetic resonance scan revealed that the mass is a solid tumor with necrotic areas. After intravenous antibiotics and fluid support, the patient was rapidly prepared for surgery. The surgical exploration showed a huge tumor originating from left lateral liver section. Left lateral sectionectomy was performed. The patient was discharged after an uneventful postoperative period. Histopathological examination revealed a HCC with over 90% coagulative necrosis with negative surgical margins. HCC can be presented with different clinical scenarios. Prompt imaging and meticulous radiologic interpretation is the key to success in the management of liver masses presenting with acute abdominal pain and fever.