Case Report: Malignancy-mimicking imaging appearances of hepatic parasitic diseases

This case report delineates a noteworthy diagnostic challenge at the intersection of hepatic infectious disease and oncology: The imaging features of atypical focal hepatic parasitic disease can overlap with those of hepatic malignancies, leading to a risk of misdiagnosis. We present a 38-year-old female with a left hepatic mass. Initial contrast-enhanced CT findings were suspicious for intrahepatic cholangiocarcinoma (ICC), yet serological tumor markers were within normal limits. Subsequent contrast-enhanced ultrasound (CEUS) revealed paradoxical tunnel-like enhancement, typically associated with hepatic paragonimiasis. However, the patient had a history of residence in a historically endemic region for schistosomiasis. Definitive histopathological analysis revealed necrotizing granulomatous inflammation with eosinophilic infiltration and Charcot-Leyden crystals, no schistosome eggs were identified. Based on positive serology for Schistosoma japonicum IgG antibodies and the patient's history of residence in an endemic region, a presumptive diagnosis of focal hepatic schistosomiasis was rendered. This case underscores that when imaging and serological findings are discordant, broadening the differential diagnosis to include such atypical parasitic infections is crucial to avoid misdiagnosis and guide appropriate therapy.