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.
•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.
•HBsAg, anti-HCV negative.
What is your differential diagnosis?
–primary, i.e. hepatocellular carcinoma, cholangiocarcinoma;
–congenital, i.e. polycystic kidney and liver disease or polycystic liver disease.
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).