Desai Gunjan, Budkule Dattaraj, Pande Prasad, Wagle Prasad
Department of Surgical Gastroenterology, MGM New Bombay Hospital, Navi Mumbai, Maharashtra, India.
Department of General Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India.
Surg J (N Y). 2020 Dec 14;6(4):e180-e184. doi: 10.1055/s-0040-1721428. eCollection 2020 Oct.
Pyrexia of unknown origin (PUO) has been a diagnostic challenge for decades. Hepatic hemangioma (HH) is not a common differential diagnosis of PUO. It is the most common benign hepatic tumor, commonly asymptomatic and incidentally detected, or can present with vague abdominal pain. PUO is a rare presenting feature. We describe a case of 38-year-old lady presenting with PUO. With no other identifiable source of fever despite exhaustive investigations, a giant hemangioma in right lobe of liver detected on abdominal ultrasonography was deemed to be the cause of PUO. The patient had sudden decrease in hemoglobin while undergoing workup, which on imaging showed a bleeding hemangioma and right hepatectomy was performed. Patient had an uneventful recovery and her PUO also resolved after surgery. HH should be considered a rare diagnosis of exclusion for PUO after a standard algorithmic approach does not reveal any other cause.
几十年来，不明原因发热（PUO）一直是一个诊断难题。肝血管瘤（HH）并非PUO常见的鉴别诊断对象。它是最常见的肝脏良性肿瘤，通常无症状，多为偶然发现，或可表现为模糊的腹痛。PUO是一种罕见的表现特征。我们描述了一例38岁女性以PUO就诊的病例。尽管进行了详尽检查，但仍未发现其他可明确的发热源，腹部超声检查发现肝脏右叶有一个巨大血管瘤，被认为是PUO的病因。患者在检查过程中血红蛋白突然下降，影像学检查显示为出血性血管瘤，遂行右肝切除术。患者恢复顺利，术后其PUO也得以缓解。在采用标准的算法方法未发现任何其他病因后，HH应被视为PUO一种罕见的排除性诊断。
