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Painful ascites
  1. S Sebastian,
  2. D Tuite,
  3. P Crotty,
  4. W Torreggiani,
  5. M J Buckley
  1. Adelaide and Meath Hospital, Dublin, Ireland
  1. Correspondence to:
    Dr Shaji Sebastian
    Department of Gastroenterology, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland; sebgastroeircom.net

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Clinical presentation

A 67 year old woman presented initially with a history of recurrent urinary tract infections. Routine imaging with ultrasound incidentally detected a 7 cm×8 cm well defined echogenic mass within the right lobe of the liver. Follow up with six monthly imaging was planned. Five months after initial presentation, the patient presented with abdominal distension and pain. Clinical examination revealed icterus, hepatomegaly, and ascites. Blood parameters were as follows: bilirubin 51 μmol/l, alanine aminotransferase 160 IU/l, alkaline phosphatase 294 IU/l, gamma glutamyl transferase 136 IU/l, albumin 37 mg/dl, haemoglobin 15.8 g/dl, WCC 8.6×109/l, platelets 337×109/l, prothrombin time 14.8 seconds, and α fetoprotein 3.1 IU/l. A contrast enhanced computerised tomography scan showed a 8×7 cm mass of predominantly fatty attenuation, caudate lobe hypertrophy, and ascites. Gadolinium enhanced magnetic resonance imaging showed that the mass was composed of fat and vascular tissue.

Question

What conclusions could be drawn from this image (fig 1)?

Figure 1

 Hepatic venography showing absence of flow in the hepatic veins.

See page 1355 for answer

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Footnotes

  • Robin Spiller, Editor

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