Gastroenterology
Case 19: A Patient with a Mass in the Upper Abdomen
CASE
An 87‐year‐old man is referred urgently after his GP had found a mass in his upper abdomen. The patient had attended with abdominal discomfort, early satiety and weight loss of 9 kg. He had a past history of heart disease having had angina for a number of years. He has chronic obstructive pulmonary disease from years of smoking. He had previously drunk heavily whilst working as a pub landlord but had not been a regular drinker of alcohol for the last ten years. He takes digoxin and warfarin for atrial fibrillation.
On examination he has evident muscle loss but no palpable lymphadenopathy. He has bilateral Dupuytren's contractures. His chest is hyperinflated and he has a few expiratory wheezes. On abdominal examination he has a prominent xiphisternum and a large mass extending below the sternum. This is dull to percussion and just moves down with inspiration. His spleen tip is just palpable but he has no detectable ascites.
Blood tests showed:
Hb 12.5 g/dL Na 130 mmol/L WCC 7.8 × 109/L K 4.2 mmol/L Platelets 105 × 109/L Urea 2.1 mmol/L Creatinine 116 µmol/L
Chest X‐ray shows hyperinflated lungs but no focal lesion or consolidation. The ultrasound requested by the GP has demonstrated a solitary 8 cm lesion in the left lobe of the liver.
QUESTION 1
Your score this session: 0 of 0
Why might the lesion demonstrated on the ultrasound cause the patient pain?