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Image of the Month—Quiz Case FREE

Julien Jarry, MD; Manu Shekher, MD; Fabien Leblanc, MD; Jean Saric, PhD
[+] Author Affiliations

Author Affiliations: Department of Hepatology, Saint Andre Hospital, University of Bordeaux, France (Drs Jarry, Leblanc, and Saric), and Intensive Care Unit, Saint Vincent Medical Center, Bridgeport, Connecticut (Dr Shekher).


Section Editor: Carl E. Bredenberg, MD


Arch Surg. 2010;145(4):397. doi:10.1001/archsurg.2010.28-a.
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A 45-year-old woman complained of persistent pain localized to the right upper abdominal quadrant and radiating to the ipsilateral shoulder. She had no fever. Her medical history was significant for a laparoscopic myomectomy 7 years prior for a uterine leiomyoma. She had no history of long-term medication and did not consume alcohol regularly. On clinical examination, she was anicteric. Her abdomen was soft and nontender, she elicited no rebound or guarding, and her test results were negative for a Murphy sign. Laboratory tests revealed the following: white blood cell count, 9100/μL (9.1 × 109/L); hemoglobin level, 15 g/dL (150 g/L); total bilirubin level, 1.29 mg/dL (22 μmol/L); aspartate aminotransferase level, 20 U/L (0.33 μkat/L); alkaline phosphatase level, 37 U/L (0.62 μkat/L); γ-glutamyl transferase level, 120 U/L (2.00 μkat/L); amylase level, 45 U/L (0.75 μkat/L); and lipase level, 51 U/L (0.85 μkat/L). Serologic tests were negative for hepatitis A, and the patient had been vaccinated for hepatitis B virus and hepatitis C virus. She underwent abdominal ultrasonography, which revealed a hepatic mass. In view of this finding, an abdominal computed tomographic (CT) scan and magnetic resonance image (MRI) scan were obtained. The MRI scan revealed evidence of a hypointense mass 6 cm in diameter within segment VII of the liver (Figure 1), which seemed vascularized by a prominent right diaphragmatic artery on the CT scan (Figure 2).

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Figure 1.

Magnetic resonance image scan of the abdomen shows a hypointense mass 6 cm in diameter within segment VII of the liver.

Graphic Jump Location

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Figure 2.

Abdominal computed tomographic scan revealing a prominent diaphragmatic artery vascularizing the tumor (arrow).

Graphic Jump Location

WHAT IS THE DIAGNOSIS?

A. Adenoma

B. Diaphragmatic leiomyoma

C. Hepatocellular carcinoma

D. Nodular focal hyperplasia

Figures

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Figure 1.

Magnetic resonance image scan of the abdomen shows a hypointense mass 6 cm in diameter within segment VII of the liver.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Abdominal computed tomographic scan revealing a prominent diaphragmatic artery vascularizing the tumor (arrow).

Graphic Jump Location

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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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