Case 35

HPI
41 y/o female c/o RUQ pain x 4 days.  Pt states pain has been intermittent, but since last night has been constant and was the worse pain since 6am today.  Pt denies any N/V/D, fever, or chills.  No hx. of gallstones, ETOH use.  Pt’s pain unrelated to eating.  No urinary complaints.

ROS
Eyes: No visual changes, eye pain, or discharge
Cardiac: No chest pain, SOB, or edema. No chest pain with exertion.
Respiratory: No cough or respiratory distress, No hempotysis
GI: + Abd pain, No N/V/D
GU: No dysuria, frequency, burning
MS: No myalgia, muscle weakness, joint pain, or back pain.
Neuro: No headaches or weakness, No LOC
Skin: No skin rash

Physical Exam
Skin: Skin is warm & dry, no acute rash
Eyes: PERRL, EOM intact; conjunctiva and sclera clear
Card: S1, S2 Normal; No murmurs, rubs, gallops, RRR
Resp: No wheezes, rales, or rhonchi
Abd: Tenderness to palpation in RUQ, Normal BS, soft, non-distended
Ext: Normal ROM, No clubbing, cyanosis, or edema.

QUESTION

  1. Based on the image below, what are your differential diagnoses?
Image 1

Image 1

ANSWER

The differential diagnosis should include: liver abscess, hepatocellular carcinoma, hydatid cyst, liver hemangioma.  This case was an example of a 15.5 cm complex cyst on the liver.