Technique:
Axial CT study for the abdomen with intravenous contrast administration,
soft tissue and bone window
Axial CT study for the abdomen with intravenous contrast administration,
soft tissue and bone window
The CT study revealed:
- multiple low attenuation ( dark ) lesions involving both hepatic lobes
- Small simple cortical cyst of left kidney
- Multiple sclerotic bony lesions involving the axial skeleton , proximal
left femur and the skull
According to the above findings:
· Multiple hemangiomas are excluded because hemangiomas with such small size
have to enhance homogenously , and the large lesions have to show peripheral nodular
enhancement, which is not the case
· Calcific lesions are excluded because in CT study it has to be bright, and of the
same bone density ( like the ribs or the spine )
· Multiple adenomas are excluded as the lesions do not enhance, and the patient
is not under contraceptive pills
· Therefore , we left with the last two possibilities , either metastasis ( specially
in the presence of the sclerotic bony deposits ) or multiple lipomas
· Echogeneic metastasis is excluded as the patient is clinically well , the CT study
reveals no apparent primary tumors and the attenuation value of these lesions are of
fat density ( CT number is below 0 ).
· Therefore such findings in the liver represent multiple lipomas
Regarding lipoma of the liver , it is extremely rare , and it is usually
associated with tuberous sclerosis , therefore I advised to do another
CT brain study for more clarification
- multiple low attenuation ( dark ) lesions involving both hepatic lobes
- Small simple cortical cyst of left kidney
- Multiple sclerotic bony lesions involving the axial skeleton , proximal
left femur and the skull
According to the above findings:
· Multiple hemangiomas are excluded because hemangiomas with such small size
have to enhance homogenously , and the large lesions have to show peripheral nodular
enhancement, which is not the case
· Calcific lesions are excluded because in CT study it has to be bright, and of the
same bone density ( like the ribs or the spine )
· Multiple adenomas are excluded as the lesions do not enhance, and the patient
is not under contraceptive pills
· Therefore , we left with the last two possibilities , either metastasis ( specially
in the presence of the sclerotic bony deposits ) or multiple lipomas
· Echogeneic metastasis is excluded as the patient is clinically well , the CT study
reveals no apparent primary tumors and the attenuation value of these lesions are of
fat density ( CT number is below 0 ).
· Therefore such findings in the liver represent multiple lipomas
Regarding lipoma of the liver , it is extremely rare , and it is usually
associated with tuberous sclerosis , therefore I advised to do another
CT brain study for more clarification