부산대학교 도서관

Aims: It is clinically challenging if intrahepatic cholangiocarcinoma (ICC) presents as a liver abscess in an initial imaging study. In these cases, clinical manifestations such as persistent fever may delay the proper diagnosis of ICC and worsen the prognosis of the patients. The purpose of this study was to compare clinical features of ICC masquerading as liver abscess with true liver abscess. Methods: A total of 287 patients initially diagnosed with liver abscess at first hospitalization, between 2001 and 2017 at a single center, were included. All patients were classified into two groups depending on whether the final diagnosis was ICC (n=21) or liver abscess (n=266). CT findings and laboratory findings of all patients with ICC and liver abscess were analyzed. Results: The most common clinical feature of the ICC group was right upper quadrant pain (71.4%), followed by fever (42.9%) and unintended weight loss (23.8%). In contrast, in the liver abscess group, fever was most common at a frequency of 80.5%, followed by right upper quadrant pain (56.0%). CT findings of capsular retraction, lymph node enlargement and focal bile duct dilatation were significantly more frequently observed. (all P values < 0.01). Findings of round outer margins, cystic components, multilayered enhancement and transient hepatic attenuation differences were significantly higher in the liver abscess group. No significantly difference was observed in proportion of alkaline phosphatase (ALP) elevation between the two groups. (ICC vs. Liver abscess: 33.3% vs. 48.9%, P = 0.183). However, elevated carbohydrate antigen (CA) 19-9 levels was more frequently observed in the ICC group than the liver abscess group. (52.4% vs 18.0, P < 0.01). Conclusions: Although there can occur difficulty distinguishing ICC from liver abscess in clinical practice, specific CT findings of ICC and abnormal CA 19-9 levels could facilitate differential diagnosis between two disease categories.