Liver abscess mimicking tumor: A pediatric case report

Abstract

A case report of a 3-year-old boy with past medical history of intestinal partially treated amebiasis, is presented. The patient was admitted to Pediatric Unit, San Cristóbal Central Hospital, Táchira, Venezuela, with abdominal pain and fever. An abdominal bloating and a 3 cm palpable hepatomegaly below the right costal margin were assessed. Abdominal ultrasound revealed a liver enlarged in the right antero-superior area. A rounded space-occupying lesion, predominantly solid, with mixed‐echo patterns, was assessed using ultrasound. The preliminary diagnosis issued was of acute medical abdomen with hepatic space-occupying lesion considered amebic liver abscess or liver tumor, moderate hypochromic microcytic anemia, and malnutrition with short stature. During the case evolution, a first computerized tomography exploration was necessary in order to exploit the capacity of this imaging technique to scan an abscess as a peripheral pseudo-capsule showing rim enhancement. Nevertheless, this theoretical shape associated with abscesses on computerized tomography scans was unable to verify in this study. At this point, the mixed-echo patterns of the preliminary ultrasound study and the imprecision of the computerized tomography scan to categorize the lesion as an abscess or a tumor, do not allow establishing a definitive diagnosis. A management based on antibiotic therapy is then proposed. The progression of the space-occupying lesion was performed using ultrasound and computerized tomography scans during the clinical evolution. The imaging controls probe a slight decrease of the liver lesion, which is diagnosed as a liver abscess. Percutaneous transhepatic drainage was performed. An amoebic liver abscess in resolution was finally diagnosed.