Time to play! [8]: the answer

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Thank you for all your comments on this case!

Please watch again the video posted below, I added some pointers.  The liver is enlarged and hypoechoic with regional hyperechoic fat.  The GB is collapsed and has a thickened wall.  On the right side of the liver, a poorly defined mass is present and contains numerous small hyperechoic foci associated with reverberation and weak shadowing, likely representing gas.  The presence of gas could be confirmed by radiographs.  Presence of intra-parenchymal gas supports anaerobic infection.  As it seems localized, surgery is recommended.

Josie went to surgery; the abnormal right medial and lateral liver lobes were partially removed. The GB was collapsed and edematous, but intact.  The histopathological diagnosis was necro-suppurative hepatitis, multifocal to coalescing, severe with intralesional bacilli.  The liver samples also contain multifocal nodular regeneration.

This entry was posted by Dominique.

6 thoughts on “Time to play! [8]: the answer

  1. thank u so much! and I have some questions about this case.
    1. did u FNA the liver before surgery, or Josie wen to surgery directly.
    2. wether we need to give some medicals to control this situation first? and what situation need to do surgery immediately?
    many thanks!


    • In Josie’s case, we did not sample the liver prior surgery. The presence of intra-parenchymal gas was enough of a signature for anaerobic infection. Surgery was considered the best choice to take care of a localized abscessation and remove the associated necrotic tissue (and rule out concurrent tumor such as adenoma, nodular hyperplasia , others).

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