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Intrahepatic Cholangiocarcinoma Masquerading as Liver Abscess: A Case Report With Multimodal Imaging.

Chunxiao Song1, Yang Xu2, Yuanyuan Zhang1

  • 1Emergency Department The Affiliated Hospital of Yangzhou University, Yangzhou University Yangzhou China.

Clinical Case Reports
|December 8, 2025
PubMed
Summary

Intrahepatic cholangiocarcinoma (ICC) can mimic liver abscesses. Recognizing atypical imaging and elevated liver enzymes like Gamma-glutamyl Transpeptidase (GGT) is crucial for early cancer diagnosis.

Keywords:
case reportintrahepatic cholangiocarcinoma (ICC)liver abscessmisdiagnosismultimodal imaging

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Area of Science:

  • Hepatobiliary medicine
  • Medical imaging
  • Oncology

Background:

  • Intrahepatic cholangiocarcinoma (ICC) frequently presents with symptoms similar to pyogenic liver abscesses, leading to potential misdiagnosis.
  • Delayed diagnosis of ICC can significantly worsen patient prognosis and treatment outcomes.

Purpose of the Study:

  • To highlight the importance of recognizing atypical presentations of intrahepatic cholangiocarcinoma.
  • To emphasize the role of multimodal imaging and specific biomarkers in differentiating ICC from liver abscesses.

Main Methods:

  • Review of clinical presentations and diagnostic workups for intrahepatic cholangiocarcinoma.
  • Analysis of imaging features across various modalities (e.g., CT, MRI, ultrasound).
  • Correlation of laboratory findings, including Gamma-glutamyl Transpeptidase (GGT), Alkaline Phosphatase (ALP), and Carbohydrate antigen 19-9 (CA19-9), with diagnostic outcomes.

Main Results:

  • Intrahepatic cholangiocarcinoma often exhibits atypical imaging characteristics that can be mistaken for pyogenic liver abscesses.
  • Markedly elevated levels of GGT, ALP, and CA19-9 are significant indicators of underlying malignancy in suspected liver abscess cases.
  • Prompt identification of these red flags can prevent diagnostic delays.

Conclusions:

  • Clinicians should maintain a high index of suspicion for intrahepatic cholangiocarcinoma when patients present with features mimicking liver abscesses.
  • A combination of atypical imaging findings and elevated liver function tests and tumor markers is essential for early detection of ICC.
  • Early and accurate diagnosis is critical for timely intervention and improved management of intrahepatic cholangiocarcinoma.