kateortamar

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From a non-GI resident, let me pick your collective brains:

Other than trauma and iatrogenic causes due to procedures, what other causes can explain a liver hematoma or fluid collection beneath the capsule?
 

bariume

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kateortamar said:
From a non-GI resident, let me pick your collective brains:

Other than trauma and iatrogenic causes due to procedures, what other causes can explain a liver hematoma or fluid collection beneath the capsule?
Here's a few..
Spontaneous hepatic cyst rupture - (simple cysts, cystadenomas,ecchinococcal);
biliary leak and subsequent biloma;
carcinoma eroding into a biliary or vascular structure.
 
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kateortamar

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bariume said:
Here's a few..
Spontaneous hepatic cyst rupture - (simple cysts, cystadenomas,ecchinococcal);
biliary leak and subsequent biloma;
carcinoma eroding into a biliary or vascular structure.
Okay, so the MRI shows no mass. There is no evidence of parasitic infection and there is no cause for a biliary leak.

The ONLY findings on MRI are subcapsular fluid consistent with resolving hematoma. Again no trauma has occurred.
 

Crypt Abscess

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Interesting scenario- I favor cyst rupture (but they probably would have seen a cyst remant on MRI).

How much fluid? Is the patient coagulopathic or on anti-coagulation? Is the patient symptomatic (RUQ pain)

Maybe IR can stick a needle in it (ultrasound guided or GI-EUS) and see what it is.


kateortamar said:
Okay, so the MRI shows no mass. There is no evidence of parasitic infection and there is no cause for a biliary leak.

The ONLY findings on MRI are subcapsular fluid consistent with resolving hematoma. Again no trauma has occurred.
 
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kateortamar

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Crypt Abscess said:
Interesting scenario- I favor cyst rupture (but they probably would have seen a cyst remant on MRI).

How much fluid? Is the patient coagulopathic or on anti-coagulation? Is the patient symptomatic (RUQ pain)

Maybe IR can stick a needle in it (ultrasound guided or GI-EUS) and see what it is.
No coagulopathy and yes occasionally symptomatic to include RUQ soreness and R shoulder/back pain occasionally but not persistent.

Also, the patient had pre-eclampsia 15 months ago.
 

DrNick2006

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Crypt Abscess said:
Interesting scenario- I favor cyst rupture (but they probably would have seen a cyst remant on MRI).

How much fluid? Is the patient coagulopathic or on anti-coagulation? Is the patient symptomatic (RUQ pain)

Maybe IR can stick a needle in it (ultrasound guided or GI-EUS) and see what it is.
Not advisable.

I think the key word here is resloving.
 

express

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Question:

what happens, when the patient has no prior symptoms, and suddenly one day feels excruciating abdominal pain?

blood test shows everything is normal.

ultrasound saw a small hemagioma.

CT scan reveals masses (not distinct tumor)...but two shades of cell tissues...

Patient feels bloating sensation and hardening beneath the diaphragm...

No cancerous traits in the blood nor bone marrow...

what can you say?...
 
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kateortamar

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DrNick2006 said:
Not advisable.

I think the key word here is resloving.
Actually after 2 months, an interim u/s was ordered and the patient has an increase of non-specific fluid (from 6 mm to 8 mm) located posterior right lobe. Again, no masses noted and the patient continues to have pain sporadically.
 

Crypt Abscess

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I would have to wonder about the signficance of 6-8mm of subcapsular fluid. Maybe MR of the liver would be able to sort things out. Crypt