Case of the Month January 2024 – Atypical appearance of a liver lesion

Camilla Palmquist Frykman^1*and Chenxi Huang²

¹ Department of Radiology, Herlev and Gentofte Hospital, Denmark; camilla.palmquist.frykman.@regionh.dk

² Department of Radiology, Copenhagen University Hospital Rigshospitalet; chenxi.huang.01@regionh.dk

* Correspondence: camilla.palmquist.frykman@regionh.dk

Clinical history

A 62-year-old man with a history of metastatic colorectal cancer had previously been treated with chemotherapy and by a combination of extensive radiofrequency ablation and resection of liver segments. A 3-month follow-up CT scan of the liver revealed possible relapse of liver metastases, but also possible abscesses. CRP was 80 mg/L. The CT was supplemented with an MRI with and without liver specific contrast agent and diffusion sequences. The MRI showed multiple lesions, among them a collection of fluid with diffusion restriction in one of the resection cavities which could be an abscess, but also other lesions that resembled metastases. Due to the large size and rapid growth of one of the lesions it was unclear whether it was a metastasis or an abscess. To clarify the diagnosis of this lesion the patient was referred to an ultrasound (US) examination with intravenous contrast agent and a supplemental biopsy for pathological and microbiological examination.

Images

Image 1: US of the liver in the right lateral intercostal space, axial plane. A. CEUS examination, arterial phase. The lesion has rapid wash-in and rapid wash-out of intravenous contrast agent. B. Same lesion on MRI, diffusion weighted sequence b800 and C. corresponding ADC map.

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