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KMID : 0964020130130020164
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Journal of the Korean Liver Cancer Study Group
2013 Volume.13 No. 2 p.164 ~ p.168
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A Case of Primary Parasternal Abscess in a Cirrhotic and Diabetic Patient with Hepatocellular Carcinoma
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Lee Ji-Young
Sohn Joo-Hyun
Kim Tae-Yeob
Lee Jung-Hoon
Chang Ki-Sul
Lee Hye-Young
Lee Hyo-Young
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Abstract
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Parasternal abscess is usually related to cardiac surgery, trauma or IV drug use and curable with antibiotics and surgical drainage. Sternal metastasis or primary parasternal abscess in a patient with hepatocellular carcinoma (HCC) is much rare and the differentiation between two diseases is occasionally difficult. Herein, we report a patient with HCC, diabetes mellitus and a spontaneously occurred parasternal abscess that is initially confused with a sternal metastasis. A-57-year-old man was admitted due to a slowly growing parasternal mass for 2 months. Two years prior to the admission, he had been diagnosed with small (1.6 cm) HCC in segment VII related to chronic hepatitis Band liver cirrhosis and treated with radiofrequency thermal ablation (RFTA). One year after RFTA, small (1.7 cm) HCC recurred in segment I and then he received TACE twiceat interval of 2 months. Eight months after that, multinodular HCCs newly developed in segment V and VIII (TNM stage IIIA) and two times of additional TACE were given. Thereafter he complained of gradually protruding mass with focal redness and mild tenderness on the sternum. But he denied any febrile and chilling sensation. Dynamic CT scans showed an enhanced parasternal lesion with bone destruction, while a bone scan displayed an increased uptake in the same site, resulting in an indistinguishable lesion between an abscess and a sternal metastasis of HCC. An excisional biopsy was performed on the lesion and revealed an abscess with sternal osteomyelitis rather than sternal metastasis. It was cured with surgical excision and antibiotics without complications.
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KEYWORD
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Cirrhosis, Diabetes mellitus, Hepatocellular carcinoma, Parasternal abscess, Transarterial chemoembolization
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