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Excellent Case! For the group - Granulomatous inflammation in the liver invokes a relatively broad differential diagnsosis. Since many of the causes are infectious, the differential tends to be geographic. Several large (and medium sized) studies of granulomas in the liver have been published ( [Ref #1], [Ref #2], [Ref #3] to list a few). Whether or not there is necrosis can help a bit (caseating vs. non-caseating - eg. TB vs sarcoid to name a few). All that said - I wonder how one gets from these images o Q-fever (not easy). Oh, and more on Q-fever here ( [Ref #4])

----Comment by: PathDoc15 on 4/28/2009 5:25:07 PM Click to add this comment's arrows to the image above

     

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