2.1 Case History, Examination and Diagnosis
A 74-year-old lady presented with right upper abdominal pain and lump
associated with early satiety for three months. There was no history of
fever or jaundice. She was a smoker for 50 pack years and had
hypertension and chronic obstructive airway disease (COPD). A general
physical examination revealed stable vitals parameters with body mass
index of 20.7 kg/m2. Abdominal examination revealed
non-tender, smooth 5cm x 5cm smooth lump over the epigastrium. Blood
investigation revealed a normal hemogram and liver function test with an
alkaline phosphatase of 61 U/ml. Serum Cancer antigen (CA) 19-9 and
carcinoembryonic antigen (CEA) were 7.8 U/ml and 0.5 ng/ml,
respectively. Cyst fluid CEA was 0.5 ng/ml and was negative for
malignant cells. Although the string test was suggestive, objective
evidence of mucin could not be evaluated at our hospital. Transabdominal
ultrasonography showed a large, well-defined cystic lesion with internal
septation and no internal vascularity in the left lobe of the liver.
Subsequently contrast enhanced computed tomography (CECT) of the abdomen
(Fig 1a &1b) showed a hepatic cyst in segment IV and Spigelian caudate
lobe with few enhancing septation with adjacent transient hepatic
attenuation difference with compression and atrophy of the left lobe of
the liver. The atrophic left lobe had a dilated intrahepatic biliary
duct, and there was communication of a few bile ducts with the cyst.
(Figure 1a & 1b)