An Uncommon Cause of a Focal Liver Lesion

Abstract

Question: A 62-year-old man with a chronic hepatitis C and liver cirrhosis Child A was referred for abdominal computed tomography (CT) after a nodular liver lesion in segment V was found on ultrasonography. His medical history included esophageal varices grade I, reflux esophagitis grade III, and a posttraumatic splenectomy 50 years ago. The physical examination was unremarkable and the laboratory values were normal (alpha-fetoprotein, 1.9 g/L). Abdominal CT scan revealed a homogenous, smoothly outlined, round lesion measuring 15 18 mm located between the gallbladder and the liver (segment V). During the arterial phase the lesion seemed to be enhanced (Figure A) and during the venous phase the lesion’s density was similar to the surrounding liver parenchyma (Figure B). To rule out small hepatocellular carcinoma, diagnostic laparoscopy was performed. The nodule could be visualized at the Calot’s triangle of the gallbladder (Figure C). We found unexpected, multiple nodules of different sizes throughout the entire left upper abdominal quadrant. These nodules were located within the greater omentum and the mesentery as well as at the peritoneal surface including the left-sided diaphragm (Figure D). Laparoscopic cholecystectomy and resection of the suspicious nodule at the Calot’s triangle was performed. The specimen was sent for histology (Figure E). The postoperative course was uneventful. What is the diagnosis? Look on page 659 for the answer and see the GASTROENTEROLOGY web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.