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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?