Clinical presentation
A 39‐year‐old female smoker presented to the gastrointestinal unit with a 6‐month history of increasing right upper quadrant pain, abdominal distension, nausea and anorexia. There was a history of dysmenorrhoea but no bowel disturbance. There was no medical history of note.
On examination, the abdomen was distended with right upper quadrant tenderness. Investigations showed a normal full blood count and normal renal and liver biochemistry. Inflammatory and tumour markers were not elevated. An abdominal ultrasound identified an enlarged liver with coarse echo texture and several focal abnormalities throughout both lobes. A CT scan of the abdomen showed multiple indeterminate areas of low attenuation within the liver (figure 1). MRI of the liver (figures 2, 3) provided further characterisation.
Figure 1 CT scan of the abdomen.
Figure 2 Axial T2‐weighted MRI scan of the abdomen.
Figure 3 Coronal T2‐weighted MRI scan of the liver.
Question
What is the diagnosis and what further investigation and follow‐up is needed?
See page 1352 for answer
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