Eosinophilic Liver Abscess Mimicking Intrahepatic Cholangiocarcinoma on 18F-FDG PET-CT: A Case Report.

Background and Clinical Significance: Eosinophilic liver abscess (ELA) is a rare benign condition that can mimic malignant liver tumors on imaging studies. The diagnostic challenge is further compounded when 18F-FDG PET-CT demonstrates high metabolic activity. Case Presentation: A 39-year-old man presented with abdominal pain, jaundice, and marked peripheral eosinophilia (34%). Imaging revealed a single liver mass with intense FDG uptake (SUVmax 10.8), highly suspicious for intrahepatic cholangiocarcinoma (ICC). Parasitic serologies were negative. Surgical resection revealed eosinophilic infiltration without malignancy. The patient remained disease-free at 1-year follow-up.

Conclusions

ELA can closely mimic ICC on PET-CT, with high FDG uptake representing a significant diagnostic pitfall. This case underscores the importance of considering ELA in the differential diagnosis of hypermetabolic liver masses in patients with peripheral eosinophilia and highlights that surgical resection remains a reasonable approach when malignancy cannot be excluded.