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J Liver Cancer > Volume 13(2); 2013 > Article
Journal of the Korean Liver Cancer Study 2013;13(2):164-168.
DOI: https://doi.org/10.17998/jlc.13.2.164    Published online September 30, 2013.
A Case of Primary Parasternal Abscess in a Cirrhotic and Diabetic Patient with Hepatocellular Carcinoma
Ji Young Lee, Joo Hyun Sohn, Tae Yeob Kim, Jung Hoon Lee, Ki Sul Chang, Hye Young Lee, Hyo Young Lee
Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
Correspondence:  Joo Hyun Sohn,
Email: sonjh@hanyang.ac.kr
Copyright ©2013 by The Korean Liver Cancer Association
Abstract
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.
Key Words: Cirrhosis; Diabetes mellitus; Hepatocellular carcinoma; Parasternal abscess; Transarterial chemoembolization
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