Pylephlebitis and liver abscess mimicking hepatocellular carcinoma

OBJECTIVE: To characterize the clinical and radiographic findings in patients with pylephlebitis andliver abscess with an emphasis on the findings that help to differentiate this disorder from portal veinocclusion associated with hepatocellular carcinoma.METHODS: We analyzed the clinical findings and radiographic images of four patients with pylephlebitisand liver abscess(es) who had been misdiagnosed as having hepatocellular carcinoma with portal veinthrombosis. Their medical records were reviewed in terms of clinical presentation, physical findings,laboratory data, treatment, and follow up.RESULTS: All patients undergoing color duplex ultrasonography had an echogenic thrombus within anexpanded portal vein with negative color-flow findings within the thrombus. Contrast enhanced CT in allthe patients demonstrated portal vein thrombosis associated with "liver masses". An intra-abdominal siteof infection responsible for the subsequent ascending infection of the portal vein and liver was notidentified in any patient on initial CT scan. At presentation, all patients were febrile and three of themhad an elevated white blood cell count as well. All patients showed abnormalities of liver function.CONCLUSIONS: Liver abscess(es) associated with pylephlebitis may mimic hepatocellular carcinomawith portal vein thrombosis. Clinical features that help to distinguish the two entities include presence orabsence of fever, elevated white blood cell count, elevated alpha-fetoprotein, cirrhosis, and risk factorsfor hepatocellular carcinoma.