Clinical Analysis of 6 Patients with Intrahepatic Cholangiocarcinoma Misdiagnosed by CT as Hepatic Abscess

ZHAO Pan; ZHANG Xiaomin; XUE Yingjie; LIU Xiaohao

doi:10.3969/j.issn.1002-3429.2024.11.004

Abstract：Objective To explore the CT features of intrahepatic cholangiocarcinoma(ICC)and the causes of misdi-agnosis as liver abscess,so as to improve the understanding of the CT features of ICC and reduce the misdiagnosis rate.Methods The data of 6 ICC patients who were misdiagnosed with liver abscess by CT from October 2021 to January 2023 were retrospectively analyzed.Results The main manifestations of 6 patients were decreased appetite,intermittent fever,up-per abdominal pain and discomfort.Among the patients,there were 2 cases of vomiting,3 cases of skin itching,1 case of fe-ver,1 case of reduced body mass and 6 cases of upper abdominal pain and loss of appetite.Plain CT revealed irregular low-density lesion with unclear contour,and enhanced CT showed mild to moderate annular enhancement and uneven internal en-hancement of the lesion.All 6 patients were misdiagnosed with liver abscess,and received anti-infective therapy.The disease continued to recur after treatment,and liver biopsy was performed;the pathological diagnosis was ICC,and misdiagnosis last-ed 15 to 42 d.Two patients had indications for surgery and underwent surgical resection,while the remaining four patients re-ceived systemic chemotherapy,combined with radiotherapy and local treatment.After 1-year follow-up,1 of the 2 patients had no recurrence and 1 died,3 of the 4 patients receiving chemotherapy died and 1 patient survived.Conclusion The clinical manifestations of ICC are nonspecific,and CT findings are not typical when necrosis and liquefaction occur in the focal center;therefore,it is more likely to be misdiagnosed as liver abscess.Attending physicians should strengthen their understanding of ICC,analyze the differential points between ICC and liver abscess,and perform liver puncture biopsy when necessary to im-prove the diagnosis rate of ICC.