Is it a Liver Tumor…or Spilled Gallstones?

A man with an abnormal liver mass who was initially believed to have a hepatic tumor was found to have a subphrenic abscess that contained spilled gallstones, shown in a November Image of the Month article in Clinical Gastroenterology and Hepatology.

As described by Takuma Arai et al., a routine checkup with ultrasonography identified an abnormal liver mass in a 65-year-old man. He had no symptoms of cancer and normal results from blood tests. However, he had undergone laparoscopic cholecystectomy for gallstones 4 years earlier.

Computed tomography and magnetic resonance imaging analyses revealed an abnormal mass in the right lobe of his liver, in contact with the diaphragm. Three months later the size of the mass had increased slightly, so the doctors suspected a malignancy.

However, during partial resection of the liver and right diaphragm, they found a subphrenic abscess that contained spilled gallstones (see below figure).

Gallstones can spill during cholecystectomy and become lost. They are frequently found in the right hypochondrium and pelvis, and form abscesses that resemble hepatic tumors.

Arai et al. conclude that it is important to consider the possibility of gallstone retention during analyses of patients with abnormal masses in a subphrenic lesion who have undergone laparoscopic cholecystectomy.

Read the article online.
Araia T, Ikeno T, Miyamoto H. Spilled gallstones mimicking a liver tumor. Clin Gastroenterol Hepatol 2012;10:A32.

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