Biliary Infarction Mimicking Liver Metastasis

Zusammenfassung

Bei einem 38-jährigen alkoholkranken Patienten mit zahlreichen Schüben einer chronisch rezidivierenden Pankreatitis, welche durch eine Pankreaskopf-Pseudozyste kompliziert war, bestand eine lang anhaltende distale biliäre Obstruktion. Bei Aufnahme litt er seit 10 Tagen unter Erbrechen, Abdominalschmerzen und Diarrhö. Sonographisch wurden zahlreiche, umschriebene, echoarme Raumforderungen in beiden Leberlappen dargestellt. Die Computertomographie zeigte nach Lage und Größe entsprechende hypodense Leberherde. Da differenzialdiagnostisch Abszesse bzw. Metastasen vermutet wurden, wurden die Leberraumforderungen sonographiegesteuert mit der Feinnadel punktiert. Die histologische Untersuchung der Leberbiopsien ergab Galleninfarkte und proliferierte Gallengänge. Hinweise für Malignität oder Infektion fanden sich nicht. Die bakteriologische Untersuchung der Leberbiopsien war kulturell negativ.

Abstract

A 38-year-old man with a history of chronic alcohol abuse had suffered from numerous acute episodes of chronic pancreatitis in the last 7 years. Those episodes were complicated by the formation of a pseudocyst in the pancreatic head. He presented himself with vomiting and abdominal pain as well as diarrhoea for 10 days. In the ultrasound examination of the liver numerous circumscribed hypoechoic formations in both lobes of the liver were found. A subsequent computerised tomography scan confirmed multiple hypodense liver lesions. Because of suspected metastasis or abscesses in the liver, sonographically guided fine needle biopsies of these liver structures were carried out. The histological examination of the liver specimens showed bile infarcts and proliferated bile ducts; there were no signs of a malignant or infectious process. The bacteriological cultures of the biopsy specimens were negative.

Schlüsselwörter

Biliäre Obstruktion - Pankreatitis - intrahepatische Gallenwegserkrankung - Ultraschall - Computertomographie

Key words

Bile duct obstruction - pancreatitis - intrahepatic biliary tract diseases - ultrasound - computerised tomography

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