Multiple Hepatic Lesions in Young Female Patient

Case at a Glance

An 18-year-old overweight female presented with multiple hepatic lesions discovered on imaging, initially identified on CT scan and further characterized by MRI with diffusion-weighted imaging abnormalities.

Patient's Story

The patient is an 18-year-old female who underwent abdominal imaging that revealed concerning liver findings. She presented as overweight with a height of 5'7". The patient expressed anxiety about the imaging results and sought clarification about the clinical significance of the findings.

Initial Assessment

Initial CT scan demonstrated a vague low-density area in the liver. The patient was referred for MRI with contrast to better characterize the hepatic lesions and rule out significant pathology.

The Diagnostic Journey

MRI revealed multiple areas of abnormality best visualized on diffusion-weighted imaging (DWI). Three distinct lesions were identified: two in the mid-right lobe measuring 2.9 cm and 1.0 cm respectively, and a third lesion measuring 1.8 cm. The lesions showed mild enhancement on post-contrast imaging but were not clearly visible on standard T1 or T2 sequences. No calcification, fat content, or biliary dilatation was observed. MRCP showed normal biliary anatomy.

Final Diagnosis

Multiple hepatic lesions of uncertain etiology with characteristic DWI restriction and mild enhancement pattern. Differential diagnosis includes lymphoma, atypical infections (particularly fungal microabscesses), drug-related hepatotoxicity, or less likely malignancy given patient's young age.

Treatment Plan

Referral to gastroenterology/hepatology for specialized evaluation. Additional laboratory studies including complete blood count with differential, liver function tests, and inflammatory markers recommended. Further imaging or tissue sampling may be considered based on clinical assessment and laboratory findings.

Outcome and Follow-up

Patient advised that while findings require investigation, primary liver malignancies are extremely rare in her age group without underlying liver disease. The imaging pattern, while concerning, is more consistent with inflammatory or infectious processes. Close follow-up with liver specialist recommended for definitive diagnosis and management plan.