Extract

A 68-year man underwent a cholecystectomy for gallstones in 2002 and a total thyroidectomy in 2008 for an adenomatoid nodule. On account of a persistently low serum calcium level since thyroidectomy, the patient had regular routine blood tests. One of these routine tests detected abnormal liver function in September 2009 (alanine aminotransferase 98 IU/l, γ-glutamyl transferase 57 IU/l; normal serum albumin, alkaline phosphatase and total bilirubin). There was no history of excessive alcohol intake nor symptoms of acute infection. Viral antibody titres suggested previous hepatitis A; autoantibody screen detected parietal cell autoantibodies. Liver ultrasound showed a large heterogenous liver mass in the right posterior liver, highly vascular on colour Doppler. Magnetic resonance imaging (MRI) scan confirmed the presence of a 10-cm heterogeneous mass. Strikingly, it also demonstrated the unusual appearance (Figure 1) of several well-defined subcapsular lesions that were low signal on T1 weighted axial images, both in and out of phase, and on T2 weighted single shot fast spin echo (SSFSE).

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