Volume 84 - 2021 - Fasc.2 - Clinical images
Right lower quadrant mass in a geriatric patient
An 88-year old man presented at the geriatric
outpatient clinic with fatigue and weakness since three
weeks. One month before presentation, he was admitted
with erysipelas of the left lower leg. After discharge, he
progressively developed loss of appetite and fatigue. The
day before presentation, he noticed a painless swollen
lump in his right lower quadrant (Figure 1A).
His medical history consisted of a transient ischemic
attack, osteopenia, polymyalgia rheumatica treated with
steroids, appendicular abscess treated with antibiotics
and percutaneous drainage six years before, gallstones,
chronic kidney disease, iron deficiency anemia and
diverticulosis.
Laboratory findings showed an elevated CRP
(191.0mg/dL [≤ 5.0mg/dL]) and mildly elevated liver
function tests. A computed tomography scan was
performed and showed a large abdominal mass
An unexpected liver lesion?
A 50-year-old woman presented with pain in her
right upper abdomen. In her medical history we note
a Caesarean section and a laparotomy with bilateral
ovariectomy because of benign cysts. The liver enzymes
were mildly elevated: aspartate transaminase 40 U/l
(reference < 32 U/l), alanine transaminase 53 U/l
(reference < 31 U/l), gamma-glutamyl transferase 97 U/l
(reference 5 – 36). Computed tomography (CT) revealed
a large lesion in the right liver lobe with a cyst within
cyst appearance and with important compression of the
surrounding tissue (figure 1, panel A). The total diameter
measured 29 cm by 17 cm by 22 cm.
Anorectal polyp
A 71-year-old female with hypertension presented
with painless rectal bleeding and found to have a soft
mass on rectal exam. The colonoscopy revealed a large
pedunculated polyp with patchy discoloration arising
from the dentate line (Fig. 1). Biopsies of the polyp were
obtained.
A rare cause of acute abdomen in a young female patient
A 37-year-old woman presented to the hospital with a
3-day history of right upper quadrant pain (RUQP), which
worsened with deep breathing. On examination, she had
fever (38°C) and RUQ tenderness. Laboratory tests
showed white-cell count of 8.1 × 109/L and C-reactive
protein level of 29.4 mg/L. Liver profiles were within
normal range (aspartate aminotransferase 20 U/L and
alanine aminotransferase 22 U/L). Immediately, contrastenhanced
computed tomography (CECT) was performed
(Figure 1). What is your diagnosis?
