title: Eosinophilic infiltration of the liver and pancreas mimicking metastatic disease.
abstract: Contrast-enhanced ultrasound (CEUS) has significantly improved the differentiation of hepatic lesions and the detection of liver metastases. Metastases are usually represented as hypoenhanced areas in the late phase and must then be confirmed histologically. Other lesions presenting hypoenhancement in the late phase are abscesses, hepatocellular and cholangiocellular carcinomas, adenomas, avascular necrosis, haematomas and rarely inflammatory masses. The differentiation between these relies on the patient's history, the number of lesions presenting, the B-image morphology and the enhancement pattern in the early phase of CEUS. We report the case of a 49-year-old woman with a in CT assumed pancreatic tumour in whom liver metastases were suspected and investigated by CEUS. In the late phase of this examination hypoenhanced hepatic lesions were observed, prompting us to perform a needle biopsy. The histopathological work-up surprisingly identified the hepatic lesions to be eosinophilic infiltration. After a spontaneous remission we concluded an allergic reaction to a fluoroquinolone.
authors.affiliation: Departement of Internal Medicine 1, Erlangen University, Erlangen, Germany. Ruediger.goertz@uk-erlangen.de
authors.forename: Rüdiger Stephan
authors.initials: RS
authors.lastname: Goertz
authors.forename: R
authors.initials: R
authors.lastname: Janka
authors.forename: A
authors.initials: A
authors.lastname: Nägel
authors.forename: D
authors.initials: D
authors.lastname: Strobel
mesh_terms: D002277:Carcinoma / Q000175:diagnosis / Q000556:secondary; D056486:Chemical and Drug Induced Liver Injury / Q000000981:diagnostic imaging* / Q000209:etiology*; D003937:Diagnosis, Differential; D004802:Eosinophilia / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D005260:Female; D024841:Fluoroquinolones / Q000009:adverse effects*; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D010190:Pancreatic Neoplasms / Q000175:diagnosis; D014463:Ultrasonography
chemical_list: D024841:Fluoroquinolones