Misidentification of hepatic tuberculosis as cholangiocarcinoma: A case report

Abstract

BACKGROUND

Hepatic tuberculosis (TB) is uncommon clinically. Because of a lack of specific signs, characteristic symptoms and clinical manifestations and because pathological samples are difficult to obtain, hepatic TB is easily missed or misdiagnosed.

CASE SUMMARY

A 62-year-old Chinese man presented with jaundice for 1 wk and no abnormal laboratory tests other than elevated bilirubin, aminotransferases and C-reactive protein. Computed tomography (CT) of the abdomen showed a mass in the left lobe of the liver and hepatic hilum with striped calcified foci. Mild enhancement was visible at the edges, along with extensive intrahepatic biliary ductal dilatation in the right lobe of the liver. In the arterial phase of both CT and magnetic resonance imaging, the main trunk and right branch of the portal artery were partially visualized. Magnetic resonance cholangiopancreatography (MRCP) indicated that the left lobe of the liver and most of the bile ducts in the hilum were not visible. Pathological examination revealed coagulative necrosis, and granulomatous nodules were seen around areas of necrosis; therefore, TB was considered.

CONCLUSION

Hepatic tuberculosis is easily misdiagnosed or missed on imaging. Percutaneous puncture biopsy is the most useful tool for definitive diagnosis.

Keywords: Hepatic tuberculosis; Pathology; Differential diagnosis; Clinical Management; Case report

Core Tip: Hepatic tuberculosis (TB) is rare in clinical practice and can also be easily missed or misdiagnosed. The clinical symptoms of hepatic TB reported in this case were atypical and a series of investigations were completed in our hospital, including computed-tomography-enhanced scans, magnetic resonance imaging multiparametric scans and pathological examination. We have also conducted a series of discussions on the case, which provide more reference for the diagnosis of hepatic TB in the future.