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case_images: Upper abdominal CT non-contrast and contrast enhanced examinations. (A) Upper abdominal CT non-contrast examination (axial) showed: there was an irregular mass-type low density lesion at the junction of the left and right lobes of the liver, which was ill-defined, with uneven density in the interior. (B-D) Sequentially, the arterial phase, venous phase, and delayed phase of upper abdominal CT contrast enhanced examination (axial) showed: the enhancement degrees of the lesion at the arterial phase and portal vein phase were lower than the normal liver parenchyma, lamellar zones without enhancement were observed inside the lesion, and edge enhancement was obvious at the delayed phase. (E) The arterial phase of upper abdominal CT contrast enhanced examination (coronal). (F) The delayed phase of upper abdominal CT contrast enhanced examination (coronal). White arrows indicates that the lesion was observed at the junction of the left and right lobes of the liver.
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case_images: The patient underwent non-contrast and contrast-enhanced upper abdominal CT to further determine the nature of the heterogeneous hypoechoic nodule at the junction of the left and right lobes of the liver revealed by ultrasound examination ( Figure 1 ).
case_images: Upper abdominal MRI non-contrast and contrast enhanced examinations. (A) T1WI of upper abdominal MRI non-contrast examination (axial) showed: hypointensity of the lesion at the junction of left and right lobes of the liver. (B, C) Sequentially, T2WI and T2-SPIR of upper abdominal MRI non-contrast examination (axial) showed: uneven hyperintensity. (D) DWI of upper abdominal MRI non-contrast examination (axial) showed: mild diffusion limitation. (E) T2-SPIR of upper abdominal MRI non-contrast examination (coronal). (F-I) Sequentially, the arterial phase, venous phase, equilibrium phase and delayed phase of upper abdominal MRI contrast enhanced examination (axial) showed: no obvious enhancement was observed on the strip-like hypointensity opacity inside the lesion, the lesion edge showed progressive enhancement. (J) The delayed phase of upper abdominal MRI contrast enhanced examination (coronal). White arrows indicates that the lesion was observed at the junction of the left and right lobes of the liver.
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case_images: Subsequently, upper abdominal MRI non-contrast and contrast-enhanced examinations were performed ( Figure 2 ), which revealed hypointensity of the lesion at the junction of the left and right lobes of the liver on T1-weighted imaging (T1WI), uneven hyperintensity on T2-weighted imaging (T2WI) and T2-spectral presaturation with inversion recovery (T2-SPIR), and mild diffusion limitation on diffusion-weighted imaging (DWI).
case_images: Pathology HE chart showed: chronic inflammation in the liver tissue, with irregular necrotic nodules locally and formation of granuloma in the surrounding epithelium, accompanied by infiltration of lymphocytes, plasmocytes and eosinophils. In addition, a small lesion of highly disintegrated polypide was seen in the necrotic nodule, conforming to parasitic disease.
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case_images: The liver mass was sent for pathological examination ( Figure 3 ), which revealed chronic inflammation in the liver tissue, with local irregular necrotic nodules and the formation of granulomas in the surrounding epithelium, accompanied by the infiltration of lymphocytes, plasmocytes, and eosinophils.
case_images: Upper abdominal postoperative MRI non-contrast and contrast enhanced examinations. (A) T2WI of upper abdominal MRI non-contrast examination (coronal) showed: postoperative changes of the liver, flake-like hypointensity in the operation area. (B-F) Sequentially, the early arterial phase (axial), late arterial phase (axial), delayed phase (coronal), venous phase and equilibrium phase (axial) of upper abdominal MRI contrast enhanced examination showed: postoperative changes of the liver, flake-like non-enhanced hypointensity in the operation area, and no obviously abnormal enhancement in the remaining liver parenchyma. White arrows indicates postoperative changes in the liver, flake-like non-enhanced hypointensity in the operative area.
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case_images: Non-contrast and contrast-enhanced upper abdominal MRI ( Figure 4 ) revealed postoperative changes in the liver, flake-like non-enhanced hypointensity in the operative area, and no abnormal enhancement in the remaining liver parenchyma.