Hepatic granulomas

Case contributed by Alexandra Stanislavsky
Diagnosis almost certain

Reformatted image from a CT cholangiogram demonstrates multiple small hepatic calcifications around a normal biliary tree (giving the appearance of a biliary tree in blossom!).  Cholecystectomy clips also present.

Case Discussion

Such calcifications are typical for healed granulomas.  The most common cause of calcified granulomas is previous tuberculosis.  Other differentials include histoplasmosis and less commonly, brucellosis or coccidioidomycosis.

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