Abdominal Pain Yields a Devastating Diagnosis
BY GREGORY TAYLOR, DO, &DIANE KAISER, DOA 41-year-old woman presented to the emergency department with abdominal pain, noting multiple episodes over the past year of intermittent right upper quadrant pain that she described as “achy” and “fullness.” These episodes occurred sporadically with no identifiable exacerbating factors. Associated symptoms included a 20-pound unintentional weight loss over two months with occasional nausea and vomiting. She was a former smoker of 10-pack years and had stopped two months prior to arrival, and she reported drinking two to three glasses of wine a week. She did not have a primary care physician.Her vital signs on arrival were a temperature of 97.7°F, blood pressure of 132/97 mm Hg, heart rate of 98 bpm, 99% pulse ox on room air, respirations of 18 bpm, and weight of 76 kg. A physical exam revealed mild tenderness to deep palpation in the RUQ with appreciable hepatomegaly. Laboratory values were remarkable for a hemoglobin of 12.7 g/dL, mean corpuscular volume of 92, gamma-glutamyl transferase of 382 (9-48 U/L), total bilirubin of 0.6, alkaline phosphatase of 205 (44-147), aspartate aminotransferase of 55 U/L (10-37 U/L), alanine aminotransferase of 33 U/L (8-37 U/L).She was hemoccult-positive on rectal exam. Ultrasound showed multiple lobulated ill-defined masses throughout the liver. (Images A and B.) A CT abdomen/pelvis showed multiple heterogeneously enhancing irregular hepatic masses, with the larges...
Publication date: Available online 13 July 2020Source: Pathology - Research and PracticeAuthor(s): Hyun Ji Son, Ha Yoon Mo, Nam Jin Yoo, Sug Hyung Lee
Publication date: Available online 13 July 2020Source: Pathology - Research and PracticeAuthor(s): Jamal Halajzadeh, Parisa Maleki Dana, Zatollah Asemi, Mohammad Ali Mansournia, Bahman Yousefi
Publication date: Available online 12 July 2020Source: Pathology - Research and PracticeAuthor(s): Milena Vuletic, Snezana Jancic, Sanja Milenkovic, Marinko Paunovic, Biljana Milicic, Nina Jancic, Biljana Perunicic, Zivana Slovic
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