case_images: PMC11663411_01
case_images: Contrast-enhanced CT scan of the abdomen and pelvis in (A) axial and (B, C) coronal sections obtained at the porto-venous phase showing a hypo-vascular geographic area with complex fluid density at the hilum of the liver with intrahepatic biliary dilatation. Non-opacification of the main portal vein with early cavernous transformation was noted as well as mild splenomegaly and ascites.
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case_images: The splenic vein appeared normal, and there were no imaging features of bowel ischemia (Fig. 1).
case_images: MRI of the liver (A, B) Axial T1WI and T2WI fat-saturated images revealing an isointense central rim with hypointense periportal edema on T1-weighted images and a hypointense rim along the portal tracts with periportal edema on T2-weighted images. (C, D) Axial T1WI postcontrast images obtained at the arterial and porto-venous phases showing mild peripheral enhancement with non-enhancement of the portal vein. (E) DWI showing minimal diffusion restriction at the hilum.
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case_images: There was also minimal diffusion restriction on diffusion-weighted images and which was confined to the periportal tracts involving the main portal and intrahepatic right and left periportal spaces. The presence of portal vein thrombosis was also confirmed (Fig. 2).
case_images: Magnetic resonance cholangiopancreatography of the liver showing dilated intrahepatic biliary radicals. Normal insertion and caliber of both cystic and common bile duct with no filling defects or irregularity to suggest impacted stones or peripheral strictures.
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case_images: Nevertheless, the common bile duct was normal in diameter (3 mm) with no filling defects (Fig. 3).
case_images: (A, B) Contrast enhanced CT scan of the abdomen and pelvis in axial and coronal sections in porto-venous phase status post-stenting showing that the hypo-vascular hypodense areas progressed compared to the initial CT with involvement of the liver parenchyma and hepatic hilum. Associated intrahepatic biliary ductal dilation and evidence of increased ascites was also noted. A pig-tail catheter tip is seen in the left lower quadrant.
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case_images: Histopathology of the liver core biopsy. (A) Inflamed necrotic/infarcted liver parenchymal tissue almost totally replaced by severe diffuse eosinophilic inflammatory infiltrates with Splendore-Hoeppli structures, Charcot Leyden crystals, hemorrhage, edema and fibrosis consistent with a hepatic abscess. Hematoxylin and eosin section x400. (B) GMS special stain reveals large broad variably sized mostly aseptate thin-walled fungal hyphae with branching morphologically consistent with zygomycotic fungal hyphae x400.
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case_images: No evidence of malignancy was seen (Fig. 5).