Peer-reviewed article
Contrast-enhanced sonography in the diagnosis of Langerhans cell hyperplasia in children with isolated liver involvement: A case report and review of the literature.
Yang L, Peng M, Ni N, Yan X, Wu Y ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This is a medical case report about diagnostic imaging of a rare liver disease (Langerhans cell histiocytosis) in an 11-year-old child. It describes how contrast-enhanced ultrasound helped identify the condition alongside other imaging techniques. The child was treated with chemotherapy and immunosuppressant therapy with reported recovery at 6-month follow-up. The report focuses on imaging diagnosis and clinical management of a specific medical condition rather than evaluating child well-being outcomes or interventions affecting broader child health.
Key points
- An 11-year-old presented with intermittent abdominal pain caused by isolated hepatic Langerhans cell histiocytosis
- Contrast-enhanced ultrasound showed a characteristic 'wash-in and wash-out' pattern in lesion periphery with non-enhancing centers
- Diagnosis was confirmed through liver biopsy, electron microscopy, and immunohistochemistry
- The patient received immunosuppressant therapy combined with prednisone and vindesine-based chemotherapy
- Follow-up at 6 months indicated favorable recovery
Limitations
This is a single case report of a rare condition, so findings cannot be generalized to other children or populations. The report does not evaluate the effectiveness of the intervention against a comparison group or provide long-term outcome data beyond 6 months.
Abstract
Rationale Isolated hepatic involvement of Langerhans cell histiocytosis (LCH) in the pediatric population is an exceedingly rare condition. Its clinical presentation is nonspecific, and its imaging features frequently overlap with those of other hepatic focal lesions, rendering preoperative diagnosis particularly challenging. Patient concerns An 11-year-old girl presented with a chief complaint of intermittent abdominal pain. Diagnoses Enhanced computed tomography and magnetic resonance imaging revealed multiple liver nodules. A characteristic imaging pattern was observed: during the portal venous and delayed phases, the periphery of the lesions exhibited a "wash-in and wash-out" enhancement pattern, while the central areas remained non-enhancing throughout all phases. This imaging finding provided a crucial diagnostic clue. The diagnosis of LCH was ultimately confirmed by liver biopsy, supplemented by electron microscopy and immunohistochemistry. Systemic evaluation verified isolated hepatic involvement. Interventions The patient received immunosuppressant therapy combined with prednisone and vindesine-based combination chemotherapy. Outcomes The patient was treated with immunosuppressant therapy and combination chemotherapy. Follow-up at 6 months indicated a favorable recovery. Lessons This case illustrates that contrast-enhanced ultrasound can effectively delineate the unique hemodynamic characteristics of hepatic LCH lesions, serving as a valuable supplement to conventional cross-sectional imaging. In the differential diagnosis of focal liver lesions in children, particularly when there is clinical suspicion for LCH, increased recognition of these specific contrast-enhanced ultrasound features is crucial. This awareness can help prevent diagnostic delays and guide targeted pathological sampling.