Diagnosis of inflammatory pseudotumor of the liver: Value of CT

OBJECTIVE. Inflammatory pseudotumor of the liver is a localized mass consisting of a fibrous stroma and chronic inflammatory infiltrate without anaplasia. Diagnosis of this rare disease is important to avoid surgery. The purpose of this study was to determine if CT is useful in the diagnosis of this lesion. SUBJECTS AND METHODS. CT scans of nine patients with a proved diagnosis of inflammatory pseudotumor of the liver were reviewed. Diagnosis was made by the surgical resection in three patients and by percutaneous biopsy in six patients. Six patients had symptoms and laboratory data suggesting active inflammation caused by the pseudotumor. The remaining three patients were asymptomatic. CT scans were performed with IV administration of the contrast material; scans were obtained in the portal venous and delayed phases in six patients and in the delayed phase in three patients. CT scans were analyzed for the number and size of the hepatic masses, and the degree and pattern of contrast enhancement on portal venous phase and delayed-phase images. RESULTS. Eight patients had a solitary hepatic mass, and one patient had two masses on the CT scan. The average size of the masses in the symptomatic patients (8.3 cm) was larger than that in the asymptomatic group (3.6 cm). CT scans in the portal venous phase showed a variable degree of contrast enhancement (seven masses). At least a part of seven masses, six of which were in symptomatic patients, showed greater contrast enhancement on delayed-phase CT scans than on the normal liver parenchyma. No constant pattern of enhancement was observed on delayed-phase CT scans in asymptomatic patients. CONCLUSION. Inflammatory pseudotumor of the liver should be included in a differential diagnosis in patients with a hepatic mass on a CT scan, especially when patients are symptomatic and the mass is fairly large and solitary showing contrast enhancement greater than that of liver parenchyma on delayed-phase CT scans. Percutaneous biopsy should be performed to obtain a histologic confirmation.