focal fatty sparing adjacent to the gallbladder

A full blood count on admission showed normal values. It may include one or more of the following: supervised medical detox behavioral therapies, such as cognitive behavioral therapy or. Age-specific prevalence was far less apparent in the younger age groups and in the elderly. Gangi, A.; Lu, S.C. Chemotherapy-associated liver injury in colorectal cancer. Kaltenbach, T.EM., Engler, P., Kratzer, W. et al. In the past 10years, comparatively few ultrasound-based studies have appeared on this subject [69]. The gender distribution of hemangioma was almost balanced, with 53.4% (n=879) women/46.6% (n=761) men. [8, 17]. ; Tanimoto, A.; Baba, Y.; Zhao, L.; Chen, J.; Middleton, M.S. Kim B, Oh J, Nam K et al. All the cases of focal fatty sparing that we encountered were solitary findings in its typical location in liver segment IV in the region of the gallbladder bed. Patient characteristics including sex, age at diagnosis, and Body Mass Index (BMI), as well as baseline comorbidities including type 2 diabetes mellitus, hyperlipidemia, and hypertension, were collected. Patients had consecutively presented from January 2003 to November 2013 and had undergone abdominal ultrasound for a variety of diseases or for preventive medical examination in the university hospital. Following initial conception of the study, the authors retrospectively identified patients who were treated and followed up by a medical oncologist at St. Michaels Hospital, Toronto, Canada, between 1 January 2006 and 1 January 2017. These segments were rarely spared in patients with previous cholecystectomy. In conclusion, the present case was difficult to diagnose because the tumor was hidden within the area of focal sparing, and dynamic contrast enhancement techniques, including CTA, CTAP and dynamic MRI, were useful for diagnosis. Extramedullary hematopoiesis (EMH) in the liver allograft presenting Thus, in this study, we sought to describe the frequency of CAS in stage IIIII CRC patients and to determine the incidence of CAS in patients who were prevalent users of statins during their adjuvant chemotherapy. Only a very few studies investigated the prevalence of FNH, hepatic adenoma, and focal fatty sparing. Of these patients, 103 individuals were treated with an oxaliplatin-containing regimen, which is FOLFOX. In the case of hepatic cysts, the range of prevalence figures from CT, MRI, or autopsy studies is also much wider than that of the ultrasound-based studies [5, 10, 15, 19, 30]. On MR images, the fatty area is hyperintense on T1- and T2-weighted images (not heavily on the latter). You seem to have javascript disabled. Please note that many of the page functionalities won't work as expected without javascript enabled. It is likely to have different pathogenesis than non-alcoholic steatohepatitis which is a diffuse process. Curr Gastroenterol Rep 17:12, Barthelmes L, Tait IS (2005) Liver cell adenoma and liver cell adenomatosis. Age-specific prevalence was far less apparent in the younger age groups and in the elderly. Unfortunately, we cannot compare our results on age and gender distribution or those concerning the average size of the hepatic adenoma with any of the studies available to us. Patients with focal fatty sparing are more often male and have a higher BMI and a larger liver than patients with nonalcoholic fatty liver disease without focal fatty sparing. Current status of imaging in nonalcoholic fatty liver disease. ; Lee, H.S. Terminology Based on the results of our study, it is necessary to conduct prospective studies that involve a larger cohort of patients, who are controlled for comorbidities that may confound the association between CRC, statin use and the incidence of steatosis. Joy, D.; Thava, V.R. In many cases, the phenomenon is believed to be related to the hemodynamics of a third inflow . is fatty lever curable? Garvey, W.T. Therefore, a fundamental knowledge of the prevalence and image morphology of hepatic hemangiomas, hepatic cysts, focal nodular hyperplasia (FNH), hepatic adenoma, and focal fatty sparing is essential. The most common site of these pseudo lesions are hepatic segments IV and V, the gallbladder bed, the falciform ligament region, and ventral to the portal vein. Abdom Radiol 41, 2532 (2016). If unusual in location or appearance then differentials to be considered include: the commonest hyperechoic liver lesion, typically well defined and may show peripheral feeding vessels, ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. On MR imaging, T1-weighted images (Fig. We investigated the potential association between adjuvant chemotherapy and the development of steatosis among patients with stage IIIII CRC. 1.1.11 Fatty liver and focal sparing | Ultrasound Cases It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Hepatic toxicity associated with fluorouracil plus levamisole adjuvant therapy. In comparison with CT, MRI, and autopsy studies, which show a far higher range of prevalence, our figure is in the lower third [10, 11, 19, 20]. It is therefore the method of choice in primary diagnostic investigations in most specialist areas of medicine, but especially for imaging the abdomen [1]. (1991) Natural history of hepatic haemangiomas: clinical and ultrasound study. Parts of this manuscript were presented at the Ultrasound Dreilndertreffen 2008, Davos. Note: data are presented as frequency (percent), unless otherwise specified. Kratzer et al. What does Focal fatty sparing is seen adjacent to the gallbladder fossa The purpose of this study was to investigate whether fatty sparing adjacent to the gallbladder fossa is related to efferent blood flow from the gallbladder wall. Furthermore, there is currently a lack of medical treatment for any population affected by steatosis, regardless of etiology, although a recently published population-based study suggests that statins may confer protective benefits against the development of steatosis. 3) showed a wedge-shaped hypointense area, as seen on non-enhanced CT, and T2-weighted images (Fig. Severe and Late Acute Liver Injury Induced by Capecitabine. Postoperative liver insufficiency and sepsis were diagnosed and intensive care including plasma exchange and administration of vancomycin was performed. Vigano, L.; De Rosa, G.; Toso, C.; Andres, A.; Ferrero, A.; Roth, A.; Sperti, E.; Majno, P.; Rubbia-Brandt, L. Reversibility of chemotherapy-related liver injury. Browning, J.D. J Ultrasound Med 14:649652, Feldman M (1958) Hemangioma of the liver. Other imaging techniques also demonstrated a wedge-shaped area which was difficult to distinguish from mere focal sparing in the fatty liver. Results with inadequate or incomprehensible written or visual documentation of the finding were excluded from the study. Scand J Gastroenterol 50:355359, Dietrich CF, Sharma M, Gibson RN, Schreiber-Dietrich D, Jenssen C (2013) Fortuitously discovered liver lesions. ; Tomlinson, J.W. For example, the prevalence of hepatic hemangioma determined in the studies ranged from 0.1% to 20.0% and that of hepatic cysts from 0.06% to 17.8%. The serum total bilirubin level rose to 19.9 mg/dl on the 11th postoperative day. With only 19 cases and hence a prevalence of 0.04%, hepatic adenoma was the rarest of the liver lesions we investigated. PubMed Haas, J.T. ; Siu, L.L. Eur J Radiol 54:388392, Vlk M, Strotzer M, Lenhart M, et al. The patient had been followed up at another hospital, and was referred to us because of abnormal CT findings and elevation of the serum CEA level. Areas of focal fatty sparing of the liver adjacent to the gallbladder and porta hepatis, absolute value of liver density less than 40 HU or a density difference greater than 25 HU between the spleen and liver on contrast-enhanced CT, increased echogenicity of the liver, attenuation of the ultrasound wave, loss of definition of the diaphragm, and poor delineation of the intrahepatic architecture on ultrasound and signal drop of liver parenchyma on the T1 weighted out of phase imaging on MRI was considered fatty liver [, A log binomial regression model was used to calculate adjusted relative risks. As regards the age distribution, the respective age-specific prevalence began with 7.0% (n=115) in the youngest patients and rose to a maximum of 22.5% (n=369) of all discovered hemangiomas in the age group between 51 and 60years. Baseline and incident steatosis for up to one year from chemotherapy start date was assessed based on radiology. The prevalence of 0.04% determined by us is considerably lower than that found in the previous studies. A zone of focal sparing was found in 67% of patients with liver steatosis (78% in patients with an intact gallbladder versus 33% in patients with previous cholecystectomy). This study sought to examine hepatic steatosis, an increasingly recognized health concern worldwide. The gallbladder is a small, pear-shaped organ on the right side of the belly (abdomen), beneath the liver. Prevalence of benign focal liver lesions: ultrasound investigation of 45,319 hospital patients. Non-enhanced CT on admission in 1996, showing a wedge-shaped hyperdense area in the anterior segment of the right lobe. Examinations were performed using following devices: Philips HDI 3000, HDI 5000, IU22, Toshiba Aplio 500, and Siemens Acuson S3000. Patient consent was waived due to retrospective nature of the study. 3). Lee, J.I. ; McKillop, J.H. 4 and 5). ; Laurie, J.A. We thank Ayesha Taqi and Aftab Malik for their generous help in the data collection process. Capecitabine: An overview of the side effects and their management. On the other hand, focal sparing in a diffusely fatty liver can be observed most frequently around the gallbladder bed, and its most common shape resembles a spot, band or ring (6). In relation to the CT, MRI, and autopsy studies, our prevalence is in the mid to lower third of the range. You are accessing a machine-readable page. volume41,pages 2532 (2016)Cite this article. ; Charlton, M. Changes in the Prevalence of hepatitis C virus infection, nonalcoholic steatohepatitis, and alcoholic liver disease among patients with cirrhosis or liver failure on the waitlist for liver transplantation. Become a Gold Supporter and see no third-party ads. However, few reports described nodular . Inclusion criterion for this analysis was a positive sonographic diagnosis of benign focal liver lesions (hepatic cysts, hepatic hemangioma, FNH, hepatic adenoma and focal fatty sparing; Figs. Chemotherapy-associated steatosis is pathologically indistinguishable from NAFLD, which has a benign onset as simple hepatic steatosis, but can asymptomatically progress to steatohepatitis [, Despite these risks, current treatment for hepatic steatosis is limited to changes in lifestyle to mitigate cardiovascular risk factors [, In this study, the primary mode of determining steatosis status in patients included a review of the medical records and the abdominal images (CT, ultrasound and MRI) by a single radiologist. J.J.K. J Ultrasound Med 14:7780, Karcaaltincaba M, Akhan O (2007) Imaging of hepatic steatosis and fatty sparing. ; Scott, B.B. The CEA level was 15.1 ng/ml and the cancer antigen 199 (CA199) level 167.4 U/ml. Ultraschall Med 30:383389, Bioulac-Sage P, Laumonier H, Couchy G, et al. Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips, Not logged in In the second part, patients with nonalcoholic hepatic steatosis and focal fatty sparing were included and underwent follow-up with sonography in the second and third years (study interval, 34-37 months; mean SD, 35.9 1.14 months). Common patterns include diffuse fat accumulation, diffuse fat accumulation with focal sparing, and focal fat accumulation in an otherwise normal liver. Allison Forrest, Sam Afshari, Naiim Ali, Ahmad Alizadeh, Fariborz Mansour-Ghanaei, Soheil Hassanipour, Carmelo Corallo, Joshua Bell, Raneem Albazaz, Feiqian Wang, Kazushi Numata, Shin Maeda, Maria Stella Franz, Antonio Bottari, Carlo Saitta, Cheng Fang, Silvia Bernardo, Paul S. Sidhu, Federica Vernuccio, Roberto Cannella, Giuseppe Brancatelli, Antonio Corvino, Fabio Sandomenico, Orlando Catalano, Abdominal Radiology Available online: Goldberg, D.; Ditah, I.C. ; Sada, Y.H. Prevalence of benign focal liver lesions: ultrasound investigation of 45,319 hospital patients, https://doi.org/10.1007/s00261-015-0605-7, Prevalence of extra-hepatic incidental findings on ultrasound screening for hepatocellular carcinoma, Imaging Accuracy in Diagnosis of Different Focal Liver Lesions: A Retrospective Study in North of Iran, Suspected focal nodular hyperplasia in male adults: 10-year experience from a large liver centre, Application of new ultrasound techniques for focal liver lesions, Rate of hepatocellular carcinoma diagnosis in cirrhotic patients with ultrasound-detected liver nodules, Characteristics of hepatic solitary necrotic nodules on contrast-enhanced ultrasonography, Contrast-enhanced ultrasound in the diagnosis of pediatric focal nodular hyperplasia and hepatic adenoma: interobserver reliability, Uncommon imaging evolutions of focal liver lesions in cirrhosis, Morphological and dynamic evaluation of complex cystic focal liver lesions by contrast-enhanced ultrasound: current state of the art, http://creativecommons.org/licenses/by/4.0/. The most commonly recorded lesion, with a total prevalence of 6.3% (n=2839), was focal fatty sparing, followed by hepatic cysts with 5.8% (n=2631). ; Kim, T.K. The varied sonographic appearances of focal fatty liver disease: Review Fan, R.; Wang, J.; Du, J. Since drug-induced hepatotoxicity was described by Grieco et al. No specific therapy is available except to eliminate the cause or treat the underlying disorder. Glucocorticoids and non-alcoholic fatty liver disease. The present case revealed a wedge-shaped area with an almost linear boundary and did not show a mass effect in the non-enhanced CT and MR sequence, including chemical shift images. The prevalence of hepatic hemangioma was 3.3% (n=1640), while that of FNH was 0.2% (n=81) and that of hepatic adenoma was 0.04% (n=19). In order to demonstrate differences between patients with and without a lesion, the Wilcoxon signed rank-sum test was applied for continuous variables and the Nodular focal fatty sparing of liver sometimes is a mimicker of malignant lesion, especially metastatic tumor. It is therefore difficult to compare the various study results and apply them to routine ultrasound primary diagnostics. Without continually carrying out new studies at regular intervals, no comparative statements concerning possible changes in the prevalence of benign focal liver lesions over time are possible. Grieco, A.; Forgione, A.; Miele, L.; Greco, A.V. Reversible hepatic steatosis in patients treated with interferon alfa-2A and 5-fluorouracil. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. In this study, Stage II-III colorectal cancer patients were retrospectively selected to evaluate the frequency of chemotherapy-associated steatosis and to determine whether patients on statins throughout adjuvant chemotherapy develop chemotherapy-associated steatosis at a lower frequency. (2015) Hepatic hemangioma in celiac patients: data from a large consecutive series. Part of Springer Nature. Hepatic steatosis is a benign condition characterized by diffuse or focal fatty infiltration of the liver parenchyma. ; Mechanick, J.I. World J Gastroenterol 19:31733188, Article In our population, a maximum occurred at between 41 and 50years of age. As with hemangioma, there are a comparatively large number of prevalence studies for hepatic cysts, but they also differ in terms of study size, patient populations investigated, and diagnostic techniques used. Disclaimer/Publishers Note: The statements, opinions and data contained in all publications are solely Andr, T.; Boni, C.; Navarro, M.; Tabernero, J.; Hickish, T.; Topham, C.; Bonetti, A.; Clingan, P.; Bridgewater, J.; Rivera, F.; et al. ; Szczepaniak, L.S. Abbreviations: BMI (Body Mass Index). Prevention of coronary heart diseases with pravastatin in men with hypercholesterolemia: West of Scotland coronary prevention study group. 5. Focal hepatic steatosis, also known as focal hepatosteatosis or (erroneously)focal fatty infiltration,represents small areas of liver steatosis. Conclusion: Detection of focal fatty sparing is associated with an increased attenuation coefficient and is thus an expression of higher-grade hepatic fatty degeneration. Check for errors and try again. permission is required to reuse all or part of the article published by MDPI, including figures and tables. The finding of a FNH or an adenoma is rarely a fortuitous result. https://doi.org/10.1007/s00261-015-0605-7, DOI: https://doi.org/10.1007/s00261-015-0605-7. This distribution is the same as that seen in focal fatty sparing and is thought to relate to variations in vascular supply. This also would account for focal fatty change/sparing sometimes seen related to vascular lesions. Introduction. Lupsor M, Badea R. Imaging diagnosis and quantification of hepatic steatosis: is it an accepted alternative to needle biopsy? J Am Soc Echocardiogr 25:553557, Kratzer W, Akinli AS, Bommer M, et al. 2001;177(5):1035-9. congenital malformations and anatomical variants. If no unequivocal and/or acceptable statements about the above-mentioned parameters could be made from the re-inspected ultrasound images, these were expanded and/or measured again. An elliptical mass surrounded by a halo was seen in the anterior segment of the right lobe, and its internal echogenicity was irregular (Fig. ; Hurley, D.L. The investigating physician is therefore increasingly faced with the problem of differentiating between malignant and benign space-occupying processes and of distinguishing the various lesions from each other [24]. Curr. The prevalence figures of the two ultrasound-based studies for FNH were 0.8% and 1.8% and lie below the figures of between 1.8% and 3.2% reported from CT, MRI, or pathological investigations [1215]. 84.2% (n=16) of patients with adenoma were women. Solitary cysts were found in 62.8% (n=1652) of cases. For Miwa, M.; Ura, M.; Nishida, M.; Sawada, N.; Ishikawa, T.; Mori, K.; Shimma, N.; Umeda, I.; Ishitsuka, H. Design of a novel oral fluoropyrimidine carbamate, capecitabine, which generates 5-fluorouracil selectively in tumours by enzymes concentrated in human liver and cancer tissue. The frequency of focal fatty sparing in patients with hepatic steatosis decreased with age and in the youngest age group of patients with hepatic steatosis, namely under 30years of age, the specific prevalence of focal fatty sparing was over 90%. The peak age for FNH occurred in the youngest patient group with 34.6% (n=28) of the diagnosed lesions and fell continuously with increasing age. The prevalence of FNH was 0.2% (n=81). The level of significance was set at =5%, and the p value was given to four decimal places. Mostbeck GH (1996) Ultrasound screening examination of the abdomen: of value or senseless? Feature papers are submitted upon individual invitation or recommendation by the scientific editors and must receive Diffuse fatty liver is a well recognized entity that is easily diagnosable by computed tomography (CT) or sonography. Here, we observed that there is a trend towards a higher rate of CAS development within one year of follow-up among stage IIIII CRC patients who received chemotherapy compared to the no treatment group. Meunier, L.; Larrey, D. Chemotherapy-associated steatohepatitis. Non-enhanced CT demonstrated a fatty liver associated with a wedge-shaped hyperdense area which occupied almost all of the anterior segment of the right lobe (Fig. Lee, M.C.M. reported a higher prevalence of hepatic hemangioma in womenresulting that we were unable to corroborate with our data (Table3) [21, 29]. Google Scholar, Collin P, Rinta-Kiikka I, Rty S, Laukkarinen J, Sand J (2015) Diagnostic workup of liver lesions: too long time with too many examinations. Demonstration of hepatic steatosis by computerized tomography in patients receiving 5-fluorouracil-based therapy for advanced colorectal cancer. Directed acyclic graphs were used to identify a minimally sufficient set of covariates to control potential confounding in the final adjusted model (, Overall, 329 patients who were diagnosed with stage IIIII CRC at St. Michaels Hospital from 1 January 2006 to 1 January 2017 were assessed for eligibility. A Feature (d) In-phase MR images show a hypointense area in the entirely hyperintense liver (TR = 120, TE = 4.2). Rofo 156:325327, Koseoglu K, Ozsunar Y, Taskin F, Karaman C (2005) Pseudolesions of left liver lobe during helical CT examinations: prevalence and comparison between unenhanced and biphasic CT findings. The understanding of hepatic adenoma has changed fundamentally in recent years [32, 33]. Findings and Implications of Focal Fatty Sparing of the Liver at Follow Ultraschall Med 17:175178, Article Chalasani, N.; Younossi, Z.; Lavine, J.; Charlton, M.; Cusi, K.; Rinella, M.; Harrison, S.A.; Brunt, E.M.; Sanyal, A.J. The number of focal lesions was considered separately up to a figure of five lesions. Multiple liver pseudotumors due to hepatic steatosis and fatty sparing CT arteriogrphy (CTA) (Fig. Focal Thickening at the Fundus of the Gallbladder: Computed Tomography Differentiation of Fundal Type Adenomyomatosis and Localized Chronic Cholecystitis. Studies concerning the prevalence of benign focal liver lesions present a quite heterogeneous picture as regards the precise research question posed, the size of the population studied, and the investigative methods used. Focal sparing shows oppsite patterns on US and CT: decreased echogenicity on US images and high attenuation on CT images. Detection of Hepatic Steatosis on Contrast-Enhanced CT Images Andr, T.; Boni, C.; Mounedji-Boudiaf, L.; Navarro, M.; Tabernero, J.; Hickish, T.; Topham, C.; Zaninelli, M.; Clingan, P.; Bridgewater, J.; et al. (2011) ISBN: 9781451118124. 3). Geographic focal fat sparing, much like focal fat infiltration involves similar areas: gallbladder fossa, medial segment near the falciform ligament, and the porta hepatis (Fig 4 a).Nodular focal fat sparing presents as hypoechoic lesions in a diffusely echogenic liver and can be extremely difficult to differentiate from true mass lesions (Fig 4 b). 3) showed an irregularly shaped hypointense area in the anterior segment. Several studies on the prevalence of focal liver lesions are primarily concerned with just one individual type of lesion or they investigate the prevalence for a given pre-existing disease [11, 1921]. Diagnosis of fatty liver disease: Is biopsy necessary? 2023 Springer Nature Switzerland AG. P.A.V. Is hepatic steatosis reversible? Del pilar fernandez M, Bernardino ME. future research directions and describes possible research applications. Pastori, D.; Polimeni, L.; Baratta, F.; Pani, A.; Del Ben, M.; Angelico, F. The efficacy and safety of statins for the treatment of non-alcoholic fatty liver disease. Focal fat deposition is slightly less common and can mimic other hepatic benign or malignant lesions on ultrasound and CT (Fig. (a) T1-weighted MR images show a wedge-shaped hypointense area, as seen on non-enhanced CT (TR = 316, TE = 11). The treatment for ALD focuses on treating alcohol use disorder. (12) reported that the basic points suggesting the presence of fatty infiltration are: 1, the abnormal area does not show an overall mass effect; 2, the vessels are normally distributed and are evident in the abnormal area. It was suggested that the tumor caused this ischemia due to intrahepatic portal vein blockade. Schumacher, J.D. Fatty change frequently shows an irregular distribution, most likely reflecting regional differences in perfusion; in areas of decreased portal flow, less fat tends to accumulate than in better-perfused areas ().This condition, called focal sparing, can occur in . Clinical patterns of hepatocellular carcinoma in nonalcoholic fatty liver disease: A multicenter prospective study. Focal hepatic steatosis | Radiology Reference Article - Radiopaedia PubMed Central By definition, fatty sparing occurs in patients with diffuse fatty infiltration of the liver, which may be idiopathic or secondary to obesity, starvation, parenteral nutrition, steroid therapy, diabetes mellitus, alcohol, and hepatitis. Dr. Yvette Kratzberganswered Pediatrics 26 years experience Talk now The gallbladder holds a digestive fluid (bile) that's released into the small intestine. ; Finn, J.P.; Stark, D.D. The majority of the more recent ultrasound-based prevalence studies show significantly higher prevalence figures than older ultrasound-based studies (Table4). Close Figure Viewer Return to Figure Previous FigureNext Figure Find support for a specific problem in the support section of our website. The data presented in this study are available on request from the corresponding author. Katsiki, N.; Mikhailidis, D.; Mantzoros, C. Non-alcoholic fatty liver disease and dyslipidemia: An update. 2 test for categorical variables, unless the sample size was too small, in which case Fishers exact test was used. Doumas, M.; Imprialos, K.; Dimakopoulou, A.; Stavropoulos, K.; Binas, A.; Athyros, V.G. Out of the 269 patients deemed eligible for analysis, 76 (28.3%) had fatty liver at baseline imaging, prior to treatment with adjuvant chemotherapy. Google Scholar, Chiche L, Adam JP (2013) Diagnosis and management of benign liver tumors. Onaya et al. 4).MRI is very useful for making the diagnosis of focal hepatic steatosis, which appears isointense or hyperintense to liver on in-phase images and loses signal on out-of-phase images. 1. Urinary Tract and male reproductive system The authors declare no conflict of interest. Fatty change frequently shows an irregular distribution, most likely reflecting regional differences in perfusion; in areas of decreased portal flow, less fat tends to accumulate than in better-perfused areas (1). CT-supported studies have reported the highest figures for prevalence [15, 19]. The statistical calculations were carried out using the statistics software SAS 9.2 (SAS Institute Inc., Cary, North Carolina, USA) and the data evaluated using descriptive statistics. Google Scholar, Linhart P, Bnhof JA, Baqu PE, Pering C (1998) Ultrasound in diagnosis of benign and malignant liver tumors. Diagnosis of focal hepatic lesions is therefore often difficult in patients with fatty infiltration. cholecystoses cholesterolosis adenomyomatosis masses gallbladder polyps gallbladder carcinoma: look for infiltration into adjacent organs, metastases, lymphadenopathy, bile duct dilatation leiomyosarcoma 1 metastases to the gallbladder: rare Epidemiology J Clin Pathol 39:183188, Article The liver was examined in inter- and/or subcostal planes with a fan-like motion allowing assessment of both the hepatic parenchyma and the intrahepatic bile ducts. CT arteriography and dynamic magnetic resonance images were useful for diagnosing this metastatic tumor.

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