RT Journal
A1 Gad H, Bojal S, Leung K, Mostafa A, Meshikhes A
T1 IMage of the month—quiz case
JF Archives of Surgery
JO Archives of Surgery
YR 2011
FD March 1
VO 146
IS 3
SP 363
OP 363
DO 10.1001/archsurg.2011.25-a
UL http://dx.doi.org/10.1001/archsurg.2011.25-a
AB 
A 27-year-old man presented with a 2-year history of progressive painless abdominal distention. While at his local hospital following a trivial abdominal trauma during a motorcycle crash, he was noted to have a huge cystic lesion of the liver on ultrasonography and computed tomography (Figure 1). Clinically, he was thin, had normal vital signs, and did not have pallor, jaundice, or lymphadenopathy. The abdomen revealed a huge mass causing marked distention in the upper abdomen, mostly in the right upper quadrant with minimal deep tenderness. Results from routine blood tests including liver function test, tumor markers, Echinococcus and Entamoeba serology, lipase level, and amylase level were all within normal limits. He electively underwent exploratory laparotomy through bilateral subcostal incision with midline extension. The operative findings were hypertrophied caudate lobe, tense and distended liver with stretched porta hepatis, and distorted anatomy (Figure 2).