8-month history of vague systemic symptoms
A 43-year-old man with no significant medical history is referred to the emergency department for evaluation of severe intermittent headaches, subjective fever, chills, weakness, abdominal pain, reduced appetite, early satiety, and a 30-lb (13.6 kg ) weight loss over the last few months.
He was in normal health until approximately 8 months ago, when he developed nonspecific abdominal pain with partial response to over-the-counter calcium carbonate and ranitidine.
Upon examination, the patient appeared to suffer from headache and abdominal pain with the following status of the body vitals:
- Oral temperature: 96.6°F (37°C)
- Pulse: Regular at a rate of 126 beats/min.
- Blood pressure: 120/82 mm Hg.
- Respiratory rate: 16 breaths/min.
The following were also noticed during the initial examination:
- No skin rashes, cyanosis, pallor, or jaundice.
- Examination of the head and neck unremarkable.
- Lungs clear to auscultation
- The cardiac evaluation demonstrates rapid S1 and S2 heart sounds without any murmurs.
- The abdomen is protuberant, with mild-to-moderate tenderness over the epigastrium and right upper quadrant along with mild voluntary guarding.
- Palpable hepatomegaly but no splenomegaly.
- No surgical scars are noted.
- Bowel sounds are present.
- Examination of extremities reveals normal findings.
An initial chest X-ray shows minimal right basilar subsegmental atelectasis; otherwise, no signs of acute cardiopulmonary disease are noted.
CT scan of the abdomen shows many low-attenuating lesions of varied size with ill-defined borders, some with water density and some with proteinaceous density in the liver. Some of these lesions demonstrate mild enhancement. Enlarged lymph nodes were seen in the left gastric region, the peripancreatic region, at the level of the celiac axis, and in the porta hepatis.
An Esophagogastroduodenoscopy (EGD) and MRI of the liver for further characterization of lesions is directed.
What’s your diagnosis (cause)?
A. Polycystic Liver disease
B. Hepatic cystadenocarcinoma
C. Metastatic esophageal cancer
D. Metastatic gastric cancer
E. Hepatic abscess
The answer to be disclosed shortly!
*Note: The present case appears in Medscape