Confluent hepatic fibrosis

Case contributed by Mónica Mariana Azor
Diagnosis almost certain


Patient with chronic liver disease and cholecystectomized, presents episodes of cholestasis, is referred to the imaging service by the hepatologist.

Patient Data

Age: 70 years
Gender: Female

The liver is dysmorphic (cirrhotic).

Capsular retractions coinciding with lesions of concave edges, visible as triangular areas, peripheral base and hilar vertex, located in segment VI and VIII, IV and to a lesser extent in segment I. They are weighted hypointense in T1 and hyperintense in T2, DWI and enhance progressively with the administration of intravenous contrast. In these sectors, the intrahepatic bile duct is ectasic.
The findings could correspond to focal confluent fibrosis.

Case Discussion

The patient after surgery, presented sepsis and hypotension, which is why her hospitalization is prolonged. When she was discharged, she experienced intermittent itching, jaundice, and fever.

It is difficult, on some occasions, to be able to differentiate diffuse fibrotic lesions of the liver parenchyma from neoplasic nodular lesions, such as intrahepatic cholangiocarcinoma. In this case, the edges of the same and their distribution are striking.
It was also useful to have a liver biopsy that was acquired during cholecystectomy available, the result of which was reported a METAVIR score A1 F1.

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