Case 24


A 64-year-old gentleman presents with increasing right upper abdominal swelling and discomfort. He denies any constitutional symptoms, and there are no symptoms of fever, chills or rigors. He has a history of hypertension.

Physical examination

Afebrile, pulse 98 bpm, BP 142/89mmHg, SaO2 98-100% on RA.

Tired-looking, hydration on the dry side.

Examination of the hands reveals no clubbing and normal-appearing palmar creases.

Head and neck examination is unremarkable.

Cardiovascular: HS dual, no murmur.

His chest is clear on auscultation.

Abdominal examination reveals a soft abdomen, mild right upper quadrant tenderness, gross hepatomegaly with a lobulated surface.

No stigmata of chronic liver disease.

No signs of oedema.


CBC is normal.

Liver and renal function tests are normal.

CRP normal.

HBsAg, anti-HCV negative.

What is your differential diagnosis?


primary, i.e. hepatocellular carcinoma, cholangiocarcinoma;

secondary metastases.

Liver abscess.

Liver cysts:

simple cysts;

congenital, i.e. polycystic kidney and liver disease or polycystic liver disease.

What would you do next?

Structural imaging of the abdomen would be helpful in delineating the various causes of hepatomegaly, i.e. ultrasonography or a computed tomography (CT) scan with contrast of the abdomen.

The following CT images are obtained (Figures 24.1 and 24.2).


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Oct 23, 2019 | Posted by in GASTROENTEROLOGY | Comments Off on 24

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