An Elderly Man with a Huge Liver

Abstract

A 71-year old male presented with generalised gradual onset abdominal distension for 15 days accompanied by abdominal discomfort without any history of loss of appetite or weight. He was a chronic tobacco chewer and a non-alcoholic. Systemic examination revealed a nodular firm liver and presence of ascites but no splenomegaly. Rest of his systemic examination was normal. His liver function tests were deranged with total bilirubin: 1.6 mg/dL (normal, 0.3–1.0 mg/dL), alanine transaminase: 74.8 (Normal, 2–45 IU/L), aspartate transaminase: 90.7 (Normal, 2–35 IU/L), serum alkaline phosphatase: 868 (Normal, 42–128 IU/L) and serum albumin 3.1 mg/dL (normal, 3.5–5 mg/dL). Alpha-fetoprotein levels were normal. A triphasic computerised tomography scan was performed, which revealed the findings depicted in Figure 1A, B, C and D respectively. Figure 1 What is the diagnosis? Answers in the page 380.