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Image of the Month—Quiz Case FREE

Théodoros Thomopoulos, MD; Gilles Mentha, MD; Christian Toso, MD, PhD
[+] Author Affiliations

Author Affiliations: Department of Surgery, Abdominal and Transplant Surgery, University Hospitals of Geneva, Switzerland.


SECTION EDITOR: CARL E. BREDENBERG, MD


JAMA Surg. 2013;148(1):99. doi:10.1001/jamasurgery.2013.410a.
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Published online

A 67-year-old female patient was referred to our hospital because of a 1-year history of intermittent right upper quadrant pain associated with anorexia and weight loss (5 kg in 6 months). Her medical history was significant for a vulvar epidermoid carcinoma (T3G2N0) 6 years ago that had been treated with vulvectomy, radiotherapy, and curietherapy. She was, thus far, free of recurrence. Ten years ago, she also underwent a complicated cholecystectomy requiring common bile duct exploration, which was not performed at our institution (the operative records were not available). Owing to her chronic abdominal pain and history of cancer, the patient underwent a positron emission tomographic/computed tomographic scan that showed a 1-cm lesion with a central fluid density that was enhanced with a contrast injection and was hypermetabolic on positron emission tomographic images of the surface of segment VI of the liver (Figure 1 and Figure 2). On admission, the patient was afebrile, with normal vital signs. The results of an abdominal physical examination were also normal, revealing only a slight right upper quadrant tenderness. The white blood cell count, the C-reactive protein level, and the liver/pancreatic function test result were within normal ranges.

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Graphic Jump Location

Figure 1. Contrast-enhanced computer tomographic scan of the abdomen showing a 1-cm lesion with a central fluid density that was enhanced with a contrast injection at the surface of segment VI of the liver (circle).

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Graphic Jump Location

Figure 2. Positron emission tomographic image revealing a hypermetabolic lesion at the surface of segment VI of the liver (circle).

WHAT IS THE DIAGNOSIS?

A.  Recurrent vulvar cancer

B.  Liver cancer

C.  Abscess due to a “lost” stone during the previous cholecystectomy

D.  Parasitic infection

Figures

Place holder to copy figure label and caption
Graphic Jump Location

Figure 1. Contrast-enhanced computer tomographic scan of the abdomen showing a 1-cm lesion with a central fluid density that was enhanced with a contrast injection at the surface of segment VI of the liver (circle).

Place holder to copy figure label and caption
Graphic Jump Location

Figure 2. Positron emission tomographic image revealing a hypermetabolic lesion at the surface of segment VI of the liver (circle).

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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