Diagnostic and treatment challenges in focal liver disease

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Abstract

Finding a focal liver lesion during screening may not uncommonly lead to a misinterpretation of the results of radiological diagnostics. Based on the consolidation of our wide experience (more than 1000 cases) of surgical treatment of patients with various focal liver diseases, we analyzed the main causes of diagnostic pitfalls and, as a consequence, errors in the treatment of these patients. The most typical objective and subjective diagnostic pitfalls that may lead to a wrong treatment strategy are discussed with clinical cases taken as examples. The objective factors are related to the rarity of disease, absence of pathognomonic semiotics, as well as limitations in the resolution power of imaging methods. In addition, a misinterpretation of results of ultrasound examination, magnetic resonance imaging and multiaxial computed tomography may be explained by identical properties of images in different tumors related to similar physical and chemical properties of a  lesion. The subjective factors are related to a wrong interpretation of clinical and instrumental assessment data, or insufficient evaluation needed in an individual patient. The number of diagnostic and treatment errors could be decreased by a multidisciplinary approach taking into account the opinions of various profile experts.

About the authors

A. V. Zhao

A.V. Vishnevsky National Medical Research Center of Surgery

Email: fake@neicon.ru

Alexey V. Zhao – MD, PhD, Professor, Deputy Director.

27 Bol'shaya Serpukhovskaya ul., Moscow, 117997

Russian Federation

G. G. Karmazanovsky

A.V. Vishnevsky National Medical Research Center of Surgery

Email: fake@neicon.ru

Grigory G. Karmazanovsky – Member-Correspondent of Russian Academy of Sciences, MD, PhD, Professor, Head of the Radiology Department.

27 Bol'shaya Serpukhovskaya ul., Moscow, 117997

Russian Federation

S. A. Bugaev

A.V. Vishnevsky National Medical Research Center of Surgery

Email: fake@neicon.ru

Sergey A. Bugaev – MD, PhD, Management Advisor.

27 Bol'shaya Serpukhovskaya ul., Moscow, 117997

Russian Federation

A. O. Chugunov

Pirogov Russian National Research Medical University

Author for correspondence.
Email: ch123@rambler.ru

Andrey O. Chugunov – MD, PhD, Associate Professor, Chair of General Surgery and Radiodiagnosis, Therapeutic Department.

1 Ostrovityanova ul., Moscow, 117997, tel.: +7 (926) 229 98 10

Russian Federation

References

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  2. Вишневский ВА, Кубышкин ВА, Чжао АВ, Икрамов РЗ. Операции на печени. Руководство для хирургов. М.: Миклош; 2003. 156 с.
  3. Hawkey CJ, Bosch J, Richter JE, Garcia-Tsao G, Chan FKL, editors. Textbook of clinical gastroenterology and hepatology. 2nd edition. Wiley-Blackwell; 2012. 1272 p.
  4. Шевченко ТВ, Паклина ОВ, Кармазановский ГГ, Яшина НИ, Жаворонкова ОИ, Мелехина ОВ, Ветшева НН, Шуракова АБ, Чжао АВ. Псевдовоспалительная опухоль печени. Доказательная гастроэнтерология. 2013;(2): 63–9.

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Copyright (c) 2018 Zhao A.V., Karmazanovsky G.G., Bugaev S.A., Chugunov A.O.

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This work is licensed under a Creative Commons Attribution 4.0 International License.

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