60-Year-Old Man With Liver Lesions and a Subcutaneous Nodule (original) (raw)
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Nodule in Liver: Investigations, Differential Diagnosis and Follow-up
Journal of clinical and experimental hepatology, 2014
Conventional ultrasonogram of the abdomen being noninvasive, inexpensive and ubiquitously available is the first imaging modality that raises suspicion of HCC in a patient with chronic liver disease with or without cirrhosis. The lesions in liver particularly nodule are being recognized with increased frequency with the wide spread use of ultrasonogram as the initial investigation and computerized tomography and magnetic resonance imaging subsequently. Any nodule in a cirrhotic liver should be considered as hepatocellular carcinoma until otherwise proved. This approach certainly is helpful in diagnosing HCC at its earliest possible stage to offer meaningful curative measures be it transplant, resection or ablative therapy. After a nodule is detected on ultrasonogram the next imaging modality can be a contrast enhanced study (dynamic CT scan or an MRI) to see if are present or not. Two vital clues for diagnosis of HCC by contrast enhanced imaging are presence of arterial hypervascula...
Journal of Surgical Oncology, 2000
In our experience, we document 2 cases of a rare and non-tumoral lesion of the liver misinterpreted as necrotic tumor: necrotic solitary nodule. In the first clinical case, ultrasound (US) showed a polylobated lesion (35 × 35 × 38 mm) at segment 8. Color-doppler identified a compression of celiac axis (Dunbar syndrome). Arteriography revealed a subtotal stenosis of celiac tripod soon after the emergence of the left gastric artery. FNAB-CT showed a highly cellulated tissue with a necrotic core surrounded by a fibersclerotic tissue. The patient underwent surgery: cholecystectomy and correction of Dunbar syndrome. US follow-up showed a progressive reduction in diameter of the lesion (24 × 25 × 25 mm at 24 months), suggesting in this case the role of ischemic injury in the pathogenesis of the lesion.
A 44-Year-Old Man With Abdominal Pain, Lung Nodules, and Hemoperitoneum
Chest, 2015
A 44-year-old man presented with a 1-day history of sudden-onset abdominal pain. The pain was characterized as severe, diff use, sharp, and nonradiating. Associated symptoms included nausea, vomiting, diarrhea, and subjective fevers. He was originally from El Salvador, but had not traveled in. 10 years. Review of systems was positive for 2 weeks of dry cough with associated mild, bilateral, pleuritic chest pain and subjective weight loss. His medical history was notable for gout and end-stage renal disease secondary to chronic nonsteroidal antiinfl ammatory drug use, for which he attended hemodialysis sessions three times weekly. Surgical history consisted of a currently nonfunctioning left upper extremity fi stula, a longstanding right internal jugular PermCath IV access for chronic hemodialysis that had been removed 2 weeks prior to presentation, and a left brachiocephalic fi stula. He did not smoke, consume alcohol, or have a history of illicit drug use.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2002
S o m e U n u s u a l C o m p l i c a t i o n s o f M a l i g n a n c i e s CASE 1. SPONTANEOUS RUPTURE OF HEPATOCELLULAR CARCINOMA DEMONSTRATED BY CONTRAST-ENHANCED SONOGRAPHY A 69-year-old man was brought to the emergency room because of the sudden onset of severe upper abdominal pain and abdominal distension. He had a known history of hepatitis B-related chronic hepatitis and liver cirrhosis for 10 years, and had been regularly checked sonographically at 3-to 12-month intervals. Occasional minimal ascites had been documented. He had been lost to clinical follow-up for 2 years. Physical examination revealed increased abdominal girth and shifting dullness on percussion. Minimal rebound pain was noted in the right upper abdomen. His temperature was 37.5°C, with a pulse rate of 84 beats/min, and his blood pressure was 80/58 mmHg. Laboratory findings showed only mild abnormalities in the serum transaminase levels (ALT, 52 U/L; AST, 45 U/L; normal, Ͻ 35 U/L for both). The alpha-fetoprotein level was 71 ng/mL (normal: 8 ng/mL), and his hemoglobin level was 10.2 g/dL. The clinical impression was liver cirrhosis with ascites, with the possibility of ruptured hepatocellular carcinoma (HCC) or perforated peptic ulcer with peritonitis or sepsis. Due to his critical condition, an urgent ultrasound (US) study of the abdomen was performed and revealed massive ascites (Fig 1, arrowheads) and an area of hypoechogenicity approximately 3 cm in size in the right hepatic lobe (Fig 1, arrows). Color Doppler US (CDU) showed color flow signals, suggesting a hypervascular tumor, especially HCC. The background of the liver showed a coarsened echo pattern with small liver size, indicative of liver cirrhosis. Spectral Doppler US of the vessels in the focal pathologic lesion showed high flow velocity (peak velocity, 33.6 cm/sec; resistive index, 0.83), suggesting that the tumor vessels were chiefly arteries (Fig 1). Because a ruptured HCC was the major concern, an echo-enhancing agent (Levovist; Schering, Berlin, Germany) was administered intravenously at a dose of 300 mg/mL (ϫ 7.5 Fig 1.
Challenging liver lesions in noncirrhotic patients: Report of three cases
Therapeutic Advances in Gastrointestinal Endoscopy
We describe three cases of liver lesions, characterized by a discrepancy between presurgical imaging and histological features, in which the final histological diagnosis was quite different from what the surgeons expected. We present (1) a case of primary liver angiomyolipoma associated with focal nodular hyperplasia, (2) a case of perivascular epithelioid cell tumor, and (3) a case of liver splenosis associated with focal nodular hyperplasia. In all cases, a presurgical diagnosis of hepatocellular adenoma was made. Due to nonspecific clinical and radiological features, these rare liver lesions are often presurgically misdiagnosed, especially in young noncirrhotic patients. The association among different lesions represents one additional diagnostic challenge.
Fortuitously discovered liver lesions
World Journal of Gastroenterology, 2013
The fortuitously discovered liver lesion is a common problem. Consensus might be expected in terms of its work-up, and yet there is none. This stems in part from the fact that there is no preventive campaign involving the early detection of liver tumors other than for patients with known liver cirrhosis and oncological patients. The work-up (detection and differential diagnosis) of liver tumors comprises theoretical considerations, history, physical examination, laboratory tests, standard ultrasound, Doppler ultrasound techniques, contrast
Solitary necrotic nodule of the liver mimicking hepatocellular carcinoma: a case report
2009
Introduction: Solitary necrotic nodule of the liver is a rare lesion, with similar radiologic findings to those of hepatic metastases or other liver masses. Case presentation: We here report a case of a 30-year-old male with hepatic solitary necrotic nodule discovered after an episode of acute abdominal pain and high grade fever. Routine laboratory data revealed leukocytosis and abnormal liver function. The imaging features of the lesion suggested malignancy or liver adenoma. The patient underwent surgical resection of segments V and VI. Histology was compatible with solitary necrotic nodule and localized vein thrombosis at the periphery. Conclusion: Solitary necrotic nodule of the liver is a benign lesion which can mimic liver malignancies. Abdominal imaging and liver biopsy are often equivocal. In such circumstances liver resection is mandatory to exclude HCC or other malignant liver lesions. Case presentation A 30-year-old Caucasian male with, no prior medical history, presented at the Emergency Department with acute right upper quadrant pain, high grade fever (38.5 C) and vomit. Laboratory tests revealed marked leukocytosis (WBC: 19810/ml) and abnormal liver function tests (AST/ALT: 218/280 IU/L, ALP/γ-GT: 123/147 IU/L, TBil: O,84 mg/ dl). Serology profile for hepatitis B or C was negative. A previous history of alcohol abuse was not documented. Abdominal US revealed a 7 cm hyperechoic lesion at the right liver lobe. Computed tomography demonstrated a single lesion, located in segments V and VI, with hemorrhagic features. After contrast administration the lesion appeared to be encapsulated with peripheral enhancement, a necrotic core and contrast wash out at the venous phase. These findings were suspicious for adenoma or HCC although fever and leukocytosis suggested a possible infectious process. No dilatation of the intra-or the extra-hepatic bil
Images in... An unusual cause of acute liver failure
2015
An 80-year-old diabetic and hypertensive lady was admit-ted with fever associated with chills and pain in the right hypochondrium of 5 days duration. On examination, she was febrile, drowsy and had asterixis. She was icteric and had tenderness with guarding in the right hypochondrium. There was no history of any pre-existing liver disease. Her haemoglobin was 9 g/dl, total leucocyte count was 11 700/mm3, platelets were 1.4 lac/mm3, total bilirubin of 3.3 mg/dl, albumin of 1.9 mg/dl, alkaline phosphatase – 227 U/l (normal 30–150 U/l), SGOT-327 U/l, SGPT-178 U/l and international normalised ratio (INR) was 2.1. Viral markers for A, B, C and E were negative. Ultrasonography showed a hypoechoic lesion in the right hepatic lobe. A CECT abdomen revealed a single 8×7 cm hypodense lesion in segments 5, 6, 7 and 8with thrombosis of the right portal