Saudi Journal of Gastroenterology
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IMAGE QUIZ  
Year : 2012  |  Volume : 18  |  Issue : 4  |  Page : 290-291
A liver lesion with systemic inflammatory manifestations


Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301, West Markham Street, Little Rock, Arkansas, USA

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Date of Web Publication13-Jul-2012
 

How to cite this article:
Agarwal A, Relia N, Bansal M, Tariq SG. A liver lesion with systemic inflammatory manifestations. Saudi J Gastroenterol 2012;18:290-1

How to cite this URL:
Agarwal A, Relia N, Bansal M, Tariq SG. A liver lesion with systemic inflammatory manifestations. Saudi J Gastroenterol [serial online] 2012 [cited 2019 Jul 22];18:290-1. Available from: http://www.saudijgastro.com/text.asp?2012/18/4/290/98441


A 50-year-old Caucasian man presented with recurrent fevers, anorexia, and 15 kg weight loss over 10 weeks. He had no abdominal pain, jaundice, or bleeding in stools. He did not smoke or drink alcohol. On physical examination, his abdomen was soft with an enlarged nontender liver. Laboratory workup showed a white cell count of 6800/mm 3 , anemia with hemoglobin of 9.4 g/dL, and elevated platelets of 466,000/mm 3 . Sedimentation rate (ESR) was greater than 140 mm/h and C-reactive protein was 76 mg/dL. Serum iron and transferrin was low with an elevated ferritin consistent with anemia of chronic disease. Liver function tests were normal except for an elevated alkaline phosphatase of 178 U/L. Computed tomography of the abdomen [Figure 1] showed a 20 cm lesion with peripheral and discontinuous nodular enhancement within the majority of the right lobe of the liver. Magnetic resonance imaging [Figure 2] showed a large heterogeneous lesion of 20 cm occupying almost the entire right lobe of the liver. There was hyperintense signal on T2-weighted images with discontinuous centripetal peripheral nodular enhancement. The lesion also had hypointense areas compatible with hemorrhage.
Figure 1: Computed tomography abdomen showing a large 20 cm heterogenous liver lesion, which demonstrates peripheral, nodular centripetal discontinuous delayed enhancement

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Figure 2: T2-weighted magnetic resonance imaging shows a large lesion with some hypointense areas compatible with hemorrhage

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Q1. What is the diagnosis?



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   References Top

1.Smyrniotis V, Kehagias D, Arkadopoulos N, Kostopanagiotou G, Labrou A, Kondi-Paphitis A. Liver hemangioma with systemic inflammatory manifestations. Am J Gastroenterol 2000;95:830-2.  Back to cited text no. 1
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2.Feder LS, Todaro JA, Laskin DL. Characterization of interleukin-1 and interleukin-6 production by hepatic endothelial cells and macrophages. J Leukoc Biol 1993;53:126-32.   Back to cited text no. 2
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3.Pol B, Disdier P, Le Treut YP, Campan P, Hardwigsen J, Weiller PJ. Inflammatory process complicating giant hemangioma of the liver: Report of three cases. Liver Transpl Surg 1998;4:204-7.  Back to cited text no. 3
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Correspondence Address:
Abhishek Agarwal
Assistant Professor of Internal Medicine, University of Arkansas for Medical Sciences, 4301, West Markham Street, Little Rock, Arkansas, 72205
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-3767.98441

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