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Case of the Month October 2023 – A liver lesion in the absence of liver disease – is it always so obvious?
WFUMB AFSUMB Student Webinar on Salivary Gland and Prostate
October 2, 2023WFUMB AFSUMB Student Webinar on Ultrasound safety, technology and development
October 20, 2023
Evelina Atanasova 1, Dimitar Popov 1, Christo Pentchev¹, Maria Petkova¹ and Christian Nolsøe2
1 Clinic of Gastroenterology, University Hospital “St. Ivan Rilski” Sofia, Bulgaria; e-mail: eva_gatanasova@abv.bg
2 Centre for Surgical Ultrasound, Department of Surgery, Zealand University Hospital, Køge, Denmark; cnolsoe@cnolsoe.dk
* Correspondence: eva_gatanasova@abv.bg
Clinical history
A 59-year-old male patient with a history of an enlarged prostatic gland and no other co-morbidities was admitted to to hospital due to urinary tract obstruction. During the abdominal and pelvic ultrasound scan a large liver lesion was found. The patient was referred to our clinic for further diagnostics.The patient had worked in a metal processing plant and had not had anintake of any toxic substances including excessive alcohol intake. At the admission he had unremarkable blood tests except for slightly elevated cholestatic liver enzymes. Hepatotropic viruses were excluded. The abdominal ultrasound including CEUS described a heterogeneous rounded lesion in the right liver lobe measuring 9.5 cm/7.3 cm, on the periphery of which small arteries were detected. Two smaller lesions measuring 3.8 cm and 1.9 cm were described. For clarification, an upper and lower endoscopy including ileoscopy was performed without any evidence of malignancy. Contrast-enhanced-CT (CE-CT) of the thorax and abdomen (arterial and venous phase for the abdomen) revealed an intensive contrast uptake in the arterial phase of the largest lesions in liver segments VI and VII with central necrotic areas in it, and wash out in the venous phase. Additionally, bone metastases were detected.
Images
Video 1: CEUS of the liver lesion in the arterial phase.
Video 2: CEUS of the liver lesion in the late venous phase.
