Cases Flashcards
(11 cards)
65‐year‐old man was referred to the outpatient hepatology clinic with a new diagnosis
of a positive hepatitis C antibody, Child‐Pugh A cirrhosis, and a focal lesion in the liver (by ultrasound). The patient reported nonspecific right upper quadrant abdominal pain,
prompting the patient to be seen in the emergency department for further evaluation.
What are the differential diagnoses?
*HCC
*Cholangiocarcinoma
*Hemangioma
*Liver abcess
*Regenerative nodular hyperplasia
B-Illustrate the diagnostic algorithm for this case?
*Triphasic ct
59 year old heavy smoker man with Child class “B” liver cirrhosis due to non-alcoholic
steatohepatitis (NASH) with no history of haematemesis or melena. He was discovered to
have a single hepatic focal lesion of 3 cm diameter in segment VI. Serum AFP was 525ng/ml.
This lesion showed hyperenhancement in arterial phase and washes out of contrast in porto
venous and delayed phases.
الاول كده ده stage كام…1
A) What are the further investigations for this patient?
Upper,PET scan,
Liver function,MELD score , assessment for portal htn
B) Prioritize the treatment options.
مرة تاتية احنا stage كام؟١
يعني RFA or Transplantation
24-year-old woman presents with persistent right upper quadrant (RUQ) discomfort for the past several months. She describes the sensation as “feeling something underneath her ribs.”
No jaundice, weight loss, or fevers.
No significant past medical history.
Laboratory tests, including a liver panel and alpha-fetoprotein (AFP), are normal.Cross-sectional imaging reveals a non-cirrhotic liver with an 8 cm lesion containing calcifications within a central scar
Diagnosis
Fibrolamellar HCC
Treatment
Surgical
What is the difference between fibrolamellar hcc and hcc
1-Prevelance
Hcc more common
2-Age
Hcc in opd age but fibrolamellar hcc in young age
3- risk factors
Hcc has risk factors as cirrhosis, alcoholic but fibrolamellar hcc has no risk factors.
4- histopathology
Hcc show malignant hepatocytes while fibrolamellar hcc show large eosinophilic cells with fibrous bands.
5- u/s
Hcc is hypoechoic but fibrolamellar hcc is hyperechoic
6- ct
Hcc show enhancement in arterial phase and washout in venous and delayed phases. But fibrolamellar hcc show enhancement in arterial phase with central scar and calcification
7- treatment..
In HCC according to stage but in fibrolamellar hcc surgical
8-AFP
Usually increase in hcc and normal in fibrolamellar hcc
9- prognosis is variable in hcc and good prognosis in fibrolamellar hcc
young woman develops acute, sharp, right upper quadrant pain. She is rushed to the
emergency department, where a CT scan reveals hemoperitoneum. Surgery fixes the prob-
lem. (This could be lots of things, but put on your “Board hat” and think of a medication-
induced complication that could explain this picture.)
Ruptured hepatic adenoma
32-year-old woman on oral contraceptives develops severe, abrupt abdominal pain. An
abdominal CT scan reveals a subcapsular mass in the liver and evidence of hemoperito-
neum. What is the culprit lesion, and what happened here?
Ruptured hepatic adenoma
32-year-old woman on oral contraceptives undergoes an abdominal CT scan to evalu-
ate recurrent abdominal pain. The scan reveals a 5-cm mass in the left lobe of the liver.
On repeat triphasic CT scanning, the lesion is found to have a central scar with fibrous-
appearing septae radiating from the scar-like spokes of a wheel. The lesion is hypodense
in the noncontrast phase and hyperdense during the hepatic arterial phase (Figure 129-1).
A follow-up nuclear sulfur-colloid liver scan reveals marked uptake of the tracer. What is
the diagnosis? Does this need to be surgically removed?
FNH,no
65-year-old man with essential thrombocytosis is found to have an isolated, elevated
ALP level. He undergoes abdominal CT, which reveals multiple hypodense nodules in the
right hepatic lobe. These are followed up with a liver biopsy, which reveals regenerative
nodules clustered around portal triads without fibrosis between the nodules. What is the
diagnosis? What medication, often used for IBD, is also associated with this diagnosis?
Regenerative nodular hyperplasia…
Aza
52-year-old obese woman with diabetes undergoes abdominal ultrasound for evalua-
tion of biliary colic. The ultrasound confirms multiple gallstones, but also reveals a 5-cm,
irregular, hypoechoic lesion in the right hepatic lobe. Follow-up CT scanning reveals a
hypodense, sharply demarcated mass. A subsequent MRI reveals increased intensity on
T1-weighted images. The contour and architecture of the liver is not distorted in either
imaging study despite presence of this lesion. What is the most likely diagnosis?
Fatty infiltration causes pseudomass
Woman on oral contraceptives has subcapsular hepatic mass on CT.
Hepatic adenoma
Young woman + liver mass with central stellate scar on CT
FNH
