0
Special Feature |

Image of the Month—Quiz Case FREE

Lucas McCormack, MD; Henrik Petrowsky, MD; Pierre-Alain Clavien, MD, PhD
[+] Author Affiliations

Swiss HPB (Hepato-Pancreato-Biliary) Centre, Department of Visceral and Transplantation Surgery, Zurich, University Hospital, Switzerland.


Section Editor: Grace S. Rozycki, MD


Arch Surg. 2007;142(4):399. doi:10.1001/archsurg.142.4.399.
Text Size: A A A
Published online

A 60-year-old woman presented with a 4-week history of a right gluteal hematoma after a mild trauma associated with asthenia and unspecific upper abdominal symptoms. On physical examination, we observed ecchymoses in the flanks, buttocks, and lower limbs. Although abdominal palpation was normal, an ultrasound revealed a large heterogeneous mass of 10 × 7 cm in the left lateral segment of the liver. A contrast-enhanced computed tomogram showed a peripheral nodular pattern of enhancement with a hypodense center (Figure 1). The hematogram revealed anemia (hematocrit value, 19%; hemoglobin level, 9.9 g/dL) and thrombocytopenia (platelet count, 77× 103/μL). Coagulation tests showed the following values: fibrinogen, 400 mg/dL (11.8 μmol/L) (reference range, 150-400 mg/dL [4.4-11.8 μmol/L]); fibrin degradation products, 1.5 μg/mL (reference range, <0.5 μg/mL); and thrombin–antithrombin III complexes, 17.4 ng/mL (reference range, <5.0 ng/mL). All other biochemical characteristics were within normal limits.

Place holder to copy figure label and caption

Contrast-enhanced computed tomogram showing a giant heterogeneous mass (arrow) occupying the left segments of the liver.

Graphic Jump Location

The patient underwent laparotomy, and the mass was successfully removed without the need of intraoperative transfusions (Figure 2). The postoperative course was uneventful, and the patient was discharged on the fifth postoperative day.

Place holder to copy figure label and caption

Intraoperative picture showing an enucleated liver lesion from the surrounding normal hepatic parenchyma. Vessels at the transection plane were controlled with silk ligatures and titanium clips. The inlay image presents the resected well-capsulated tumor.

Graphic Jump Location

WHAT IS THE DIAGNOSIS?

 Kasabach-Merritt syndrome

 Hemangiosarcoma

 Klippel-Trenaunay syndrome

 Rendu-Osler-Weber syndrome (hereditary hemorrhagic telangiectasia)

Figures

Place holder to copy figure label and caption

Contrast-enhanced computed tomogram showing a giant heterogeneous mass (arrow) occupying the left segments of the liver.

Graphic Jump Location
Place holder to copy figure label and caption

Intraoperative picture showing an enucleated liver lesion from the surrounding normal hepatic parenchyma. Vessels at the transection plane were controlled with silk ligatures and titanium clips. The inlay image presents the resected well-capsulated tumor.

Graphic Jump Location

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
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.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics