Photopenic appearance of the hepatic lesion (s) on technetium-99m red blood cell imaging

Abstract

A 63-YEAR-OLD MAN with a history of ethanol and tobacco abuse complained of indigestion, heartburn, and dyspepsia. In 1974, he underwent liver biopsy; acute alcoholic hepatitis with cirrhosis was diagnosed. A physician examination showed an enlarged liver palpable 14 cm below the right costal margin with tenderness, engorgement of the superficial abdominal wall veins, and shifting dullness, indicating ascites. Palmar erythema and mild pitting edema in the lower extremities were also present. A computed tomography (CT) scan of the abdomen showed a large, low-density lesion in the central portion of the right lobe of the liver (Fig 1). Since he was scheduled to undergo biopsy of this lesion, the patient was referred for technetium-99m red blood cell (99mTc-RBC) liver imaging to rule out a hemangioma. The study showed hepatomegaly with a photopenic area (Fig 2) corresponding to the lesion on the CT seen in immediate, 15-minute, 30minute, 1-hour, and 3-hour images, consistent with avascular mass or tumor mass undergoing necrosis. Alpha-fetoprotein was 12,000 nL/L (N = < 10 ng/L) and hepatitis B surface anti-