A Case of Inflammatory Pseudotumor of the Liver with Septic Shock and Disseminated Intravascular Coagulation

Daiji Iwami, Izumi Mochizuki, Tatsuya Nakano, Takuji Hirano, Hiroshi Kikuchi, Takashi Sasaki and Tsutomu Sakuma*

Department of Surgery and Department of Pathology*, Iwate Prefectural Central Hospital

We report a case of inflammatory pseudotumor of the liver with septic shock and disseminated intravascular coagulation. A 51-year-old woman admitted for fever and right hypochondralgia and referred due to a hepatic mass lesion detected by abdominal computed tomography (CT) was found on admission to have blood pressure of 77/51 mmHg and laboratory data showing disseminated intravascular coagulation with decreased platelet counts and increased FDP. Imaging diagnosis following ultrasonography (US), CT, and magnetic resonance imaging showed a space-occupying lesion 8 cm in diameter in the right hepatic lobe. Selective hepatic angiography showed tumor staining and occlusion of the anterior branch of the right portal vein. Fine needle aspiration biopsy under US to determine a definitive diagnosis showed that the lesion consisted of numerous lymphocytes and neutrophils without malignant pathological features. Cultures from the lesion grew Streptococcus species, leading to suspicion of an inflammatory pseudotumor. Conservative therapy using antibiotics had no effect on the inflammatory reaction, necessitating exploratory surgery and right hepatectomy and cholecystectomy. The cut surface of the lesion showed a yellowish white solid tumor with scattered microabscesses. Pathological examination yielded a definitive diagnosis of inflammatory pseudotumor. The patient recovered without complications and remains well without symptom recurrence in the 3 years since her operation.

Key words
inflammatory pseudotumor of the liver, septic shock, hepatectomy

Reprint requests
Daiji Iwami Department of Surgery, Hachinohe City Hospital
1 Bishamondaira, Tamukai, Hachinohe, 031-8555 JAPAN

Accepted
January 25, 2006

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