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An elderly male presented with acute upper abdominal pain and tenderness with dyspnoea. On examination he had tachypnoea, tachycardia, hepatomegaly, and tenderness in the right upper quadrant and epigastrium. He also appeared jaundiced and had peripheral oedema of the lower limbs.
Laboratory findings were: aspartate transaminase 118 IU/l (normal range 0–32); alkaline phosphatase 430 IU/l (normal range 60–240); and bilirubin 40 μmol/l (normal range <20).
Chest radiograph performed at presentation suggested a mediastinal mass. Multidetector row computed tomography of the thorax and abdomen was performed for further assessment (fig 1A, B).
What is the diagnosis?
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This case is submitted by:
Robin Spiller, editor