CC: abdominal discomfort and distension
ID: 33 yo female with asthma presents to an OSH ED with abdominal discomfort, distension, fatigue, and difficulty sleeping. She underwent an abdominal ultrasound and was found to have a liver lesion, concerning for abscess, and was also incidentally discovered to be pregnant. She was transferred to USC for higher level care. Repeat abdominal US demonstrated a solid liver lesion suspicious for focal nodular hyperplasia or hepatic adenoma. She subsequently underwent an MRI that was read to be a nonspecific liver lesion. She then underwent a liver mass biopsy and results were suggestive of a hemangioma.
Pearls from morning report:
- Even if a patient does not have risk factors for HCC (ie. chronic hepatitis or cirrhosis), a specific type of liver malignancy, fibrolamellar carcinoma, can still arise in younger individuals.
- Hemangiomas are the most common benign hepatic tumor and most often asymptomatic with a low rate of complications, thus does not require surgical resection.
- Consider the use of antifungals for liver abscesses in neutropenic patients or patients on longer term TPN, and MRSA coverage for staph after recent instrumentation (such as TACE).
Random trivia:
Hemangiomas may sequester platelets during surgery or other insults, triggering a bleeding diathesis and possibly internal bleeding. The triad of a giant hemangioma, thrombocytopenia, and consumptive coagulopathy is known as the Kasabach-Merritt Syndrome.
References:
Marrero JA, Ahn J, Rajender Reddy, American College of Gastroenterology. ACG clinical guideline: the diagnosis and management of focal liver lesions. Am J Gastroenterol. 2014;109(9):1328-47.
Schwartz JM, Kuskal JB, Chopra S, Robson KM. Solid liver lesions: Differential diagnosis and evaluation. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on March 16, 2017)