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
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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