Deceptive Tumors in A Middle-Aged Woman

Abstract

A 50-year-old woman consults for pain in the epigastrium and right hypochondrium, nausea, and vomiting of approximately eight months of evolution. Laboratory results showed an alkaline phosphatase of 116 U/L and the following viral profile: anti-HAV IgG 9.89 S/Co, anti-CMV IgG 64.4 IU/ml, anti-CMV IgG > 250 AU/ml, anti-Epstein Barr IgG 65.67 S/Co. The rest of the results were normal and the serologies were negative.

Subsequently, an abdominal ultrasound showed innumerable hypoechogenic nodules, with partially circumscribed margins, with calcifications inside, some causing capsular retraction, without evidence of vascular flow with color Doppler (Figure 1). After these findings, the evaluation is continued by MDCT (Multi-detector Computed Tomography) with intravenous contrast, where numerous isodense and hypodense nodules, with ring enhancement in arterial and venous phases, distributed in both hepatic lobes, are observed, in agreement with the ultrasound. In the left lobe, a dominant nodule stands out, accompanied by gross internal calcifications, measuring 48x42x39 mm (Figure 2).