1. Case Presentation
A 79-year-old woman with no known systemic disease presented to the emergency department with right upper abdominal pain persisting for 3 weeks and a recent onset of vaginal bleeding. She was afebrile, with a pulse of 100 beats per minute and a blood pressure of 182/92 mm Hg. Physical examination revealed tenderness in the right upper quadrant without muscle guarding. Point-of-care ultrasound showed fluid around the liver (Fig 1); whereas, computed tomography imaging revealed a significant fluid collection in the liver's subcapsular space and a smudged omentum (Fig 2A,B). Transvaginal sonography identified a likely malignant right ovarian mass (Fig 3). The patient underwent drainage in the emergency department, followed by debulking surgery upon admission.
Figure 1.
Point-of-care ultrasonography demonstrates a massive localized perihepatic fluid-like lesion (asterisk).
Figure 2.
A. Contrast-enhanced computed tomography scan of the abdomen demonstrates a large fluid lesion in the subcapsular space of the liver (asterisk). B. Contrast-enhanced computed tomography scan of the abdomen demonstrates a smudged appearance of the omentum (arrow).
Figure 3.
Transvaginal sonography demonstrates a mass lesion of the right ovary (circle).
2. Diagnosis: High-Grade Papillary Serous Carcinoma of the Right Ovary With Peritoneal Carcinomatosis and Extensive Subcapsular Fluid in the Liver
Hepatic subcapsular fluid can result from hematomas, tumors, liver abscesses, bilomas, or other causes.1 High-grade papillary serous carcinoma (HGSC) is the most common type of ovarian cancer, often diagnosed at advanced stages (III-IV) with a poor prognosis. The peak age range is 45 to 65 years, with a mean of 57 years.2,3 The clinical presentation of HGSC may be acute (ascites, pleural effusion, and bowel obstruction) or subacute (pelvic and abdominal symptoms and vaginal bleeding). Metastatic hepatic involvement in HGSC typically includes perihepatic peritoneal metastasis and hematogenous liver metastases.4 However, such a large accumulation of hepatic subcapsular fluid as an initial presentation is relatively uncommon. The patient has received postoperative chemotherapy and has been followed for 2 years.
Funding and Support
By JACEP Open policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist.
Conflict of Interest
All authors have affirmed they have no conflicts of interest to declare.
Footnotes
Supervising Editor: Chad Andicochea, DO, MS
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