{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T05:24:35Z","timestamp":1768454675091,"version":"3.49.0"},"reference-count":29,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,9,8]]},"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:p>A man in his 30s had presented with a history of abdominal pain, vomiting and high-grade fever. He had tender hepatomegaly with peritonism in the upper abdomen. Investigations revealed a neutrophilic leucocytosis, and contrast-enhanced CT had shown several well-defined peripherally enhancing thick-walled cystic lesions with non-enhancing centres throughout the liver suggestive of pyogenic liver abscess, treated initially with antibiotics. However, ultrasonography-guided fine needle aspiration revealed atypical neoplastic cells, and a trucut biopsy showed squamous cell carcinoma (SCC). He developed acute shortness of breath. CT pulmonary angiogram confirmed pulmonary thromboembolism (PTE). Incidentally, here we saw a solitary nodule in the right middle lobe, probably a neoplastic lesion. His condition deteriorated rapidly secondary to PTE and died. A pathological review was positive for CK7, p40, p63 and CK19 confirming SCC. We concluded the primary was a pulmonary SCC with multiple hepatic metastases. Hepatic metastases can mimic an abscess; trucut biopsy with immunohistochemistry was critical for a definitive diagnosis.<\/jats:p>","DOI":"10.1136\/bcr-2022-250489","type":"journal-article","created":{"date-parts":[[2022,9,21]],"date-time":"2022-09-21T14:02:25Z","timestamp":1663768945000},"page":"e250489","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Unique diagnostic challenge in surgery: hepatic abscess versus malignancy"],"prefix":"10.1136","volume":"15","author":[{"given":"Shrenik","family":"Govindaraj","sequence":"first","affiliation":[{"name":"Department of General Surgery and Laparoscopy, St John's Medical College Hospital, Bangalore, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clement","family":"Prakash","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Laparoscopy, St John's Medical College Hospital, Bangalore, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anuradha","family":"Ananthamurthy","sequence":"additional","affiliation":[{"name":"Department of Pathology, St John's Medical College Hospital, Bangalore, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8086-9499","authenticated-orcid":false,"given":"Sridar","family":"Govindaraj","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Laparoscopy, St John's National Academy of Health Sciences, Bangalore, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,9,21]]},"reference":[{"key":"2025082712202898000_15.9.e250489.1","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.ijsu.2018.10.028","article-title":"The scare 2018 statement: updating consensus surgical case report (scare) guidelines","volume":"60","author":"Agha","year":"2018","journal-title":"Int J Surg"},{"key":"2025082712202898000_15.9.e250489.2","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.ijsu.2018.10.031","article-title":"The process 2018 statement: updating consensus preferred reporting of case series in surgery (process) guidelines","volume":"60","author":"Agha","year":"2018","journal-title":"Int J Surg"},{"key":"2025082712202898000_15.9.e250489.3","unstructured":"Kew MC . Tumors of the liver. In: Zakim D , Boyer TD , eds. Hepatology: a textbook of liver disease. 3rd ed. Baltimore WB: Saunders, 1996: 1513\u201328."},{"key":"2025082712202898000_15.9.e250489.4","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1002\/hep.1840130414","article-title":"Hepatocellular carcinoma presenting with pyrexia and leukocytosis: report of five cases","volume":"13","author":"Okuda","year":"1991","journal-title":"Hepatology"},{"key":"2025082712202898000_15.9.e250489.5","doi-asserted-by":"publisher","DOI":"10.1148\/radiographics.21.4.g01jl16895"},{"key":"2025082712202898000_15.9.e250489.6","doi-asserted-by":"publisher","DOI":"10.1007\/s002619900347"},{"key":"2025082712202898000_15.9.e250489.7","doi-asserted-by":"publisher","DOI":"10.2463\/mrms.6.43"},{"key":"2025082712202898000_15.9.e250489.8","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.159.1.1302463"},{"key":"2025082712202898000_15.9.e250489.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2007.09.008"},{"key":"2025082712202898000_15.9.e250489.10","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.ejrad.2019.02.024","article-title":"Differentiation of liver abscess from liver metastasis using dual-energy spectral CT quantitative parameters","volume":"113","author":"Wang","year":"2019","journal-title":"Eur J Radiol"},{"key":"2025082712202898000_15.9.e250489.11","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1007\/BF03167790","article-title":"Hepatic abscesses in elderly patients mimicking metastatic disease","volume":"170","author":"Ryan","year":"2001","journal-title":"Ir J Med Sci"},{"key":"2025082712202898000_15.9.e250489.12","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1111\/j.1572-0241.1998.00253.x","article-title":"Cholangiocarcinoma presenting as pyogenic liver abscess: is its outcome influenced by concomitant hepatolithiasis?","volume":"93","author":"Jan","year":"1998","journal-title":"Am J Gastroenterol"},{"key":"2025082712202898000_15.9.e250489.13","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1148\/radiology.154.3.3969480","article-title":"Dynamic CT features of hepatic abscesses","volume":"154","author":"Mathieu","year":"1985","journal-title":"Radiology"},{"key":"2025082712202898000_15.9.e250489.14","doi-asserted-by":"crossref","first-page":"727","DOI":"10.3348\/jkrs.1999.40.4.727","article-title":"Hepatic abscess: three-phase helical CT appearance","volume":"40","author":"Chung","year":"1999","journal-title":"J Korean Radiol Soc"},{"key":"2025082712202898000_15.9.e250489.15","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.09090021"},{"key":"2025082712202898000_15.9.e250489.16","unstructured":"Akhondi H , Sabih DE . Liver abscess. In: StatPearls. StatPearls Publishing, 2020."},{"key":"2025082712202898000_15.9.e250489.17","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-007-9467-8"},{"key":"2025082712202898000_15.9.e250489.18","doi-asserted-by":"publisher","DOI":"10.2217\/lmt.12.40"},{"key":"2025082712202898000_15.9.e250489.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbcan.2015.08.002"},{"key":"2025082712202898000_15.9.e250489.20","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1385\/MO:20:1:25","article-title":"Liver metastasis at the time of initial diagnosis of lung cancer","volume":"20","author":"Kagohashi","year":"2003","journal-title":"Med Oncol"},{"key":"2025082712202898000_15.9.e250489.21","doi-asserted-by":"crossref","first-page":"129","DOI":"10.4251\/wjgo.v9.i3.129","article-title":"Lung cancer metastasis to the gastrointestinal system: an enigmatic occurrence","volume":"9","author":"Badipatla","year":"2017","journal-title":"World J Gastrointest Oncol"},{"key":"2025082712202898000_15.9.e250489.22","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000011027","article-title":"Multiple gastrointestinal metastases of squamous-cell lung cancer: a case report","volume":"97","author":"Li","year":"2018","journal-title":"Medicine"},{"key":"2025082712202898000_15.9.e250489.23","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.10644"},{"key":"2025082712202898000_15.9.e250489.24","doi-asserted-by":"crossref","first-page":"12","DOI":"10.4251\/wjgo.v7.i3.12","article-title":"Gastric metastasis from primary lung adenocarcinoma mimicking primary gastric cancer","volume":"7","author":"Kim","year":"2015","journal-title":"World J Gastrointest Oncol"},{"key":"2025082712202898000_15.9.e250489.25","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0b013e318074de1b"},{"key":"2025082712202898000_15.9.e250489.26","doi-asserted-by":"publisher","DOI":"10.1007\/s00408-013-9485-1"},{"key":"2025082712202898000_15.9.e250489.27","first-page":"2045","article-title":"[Clinical characteristic and outcomes of lung cancer patients with venous thromboembolism]","volume":"94","author":"Xu","year":"2014","journal-title":"Zhonghua Yi Xue Za Zhi"},{"key":"2025082712202898000_15.9.e250489.28","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2011-0521-OA"},{"key":"2025082712202898000_15.9.e250489.29","doi-asserted-by":"crossref","first-page":"3046","DOI":"10.7150\/jca.26008","article-title":"Lung cancer and pulmonary embolism: what is the relationship? A review","volume":"9","author":"Li","year":"2018","journal-title":"J Cancer"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2022-250489","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T19:20:40Z","timestamp":1756322440000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2022-250489"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9]]},"references-count":29,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9,21]]},"published-print":{"date-parts":[[2022,9]]}},"alternative-id":["10.1136\/bcr-2022-250489"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2022-250489","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9]]}}}