Gastroenterology clinical image challenge: A 50-year-old woman with a past medical history of hypertension and poliomyelitis was referred to the emergency department with suspected pneumonia. She complained of having experienced general weakness for a few weeks. She had no history of alcohol consumption or cigarette smoking. Notable laboratory test results included a white blood cell count of 13,470/mm3, hemoglobin 7.6 g/dL, C-reactive protein 36.02 mg/dL, aspartate aminotransferase 101 IU/L, alanine aminotransferase 177 IU/L, alkaline phosphatase 241 IU/L, gamma glutamyl transferase 239 IU/L, albumin 3.03 g/dL, blood urea nitrogen 41 mg/dL, and creatinine 1.44 mg/dL.
A computed tomography (CT) scan of the chest revealed diffuse interlobular septal thickening and increased attenuation of both lungs suggestive of pulmonary edema. Additionally, multiple low attenuated lesions in the both lobes of the liver were detected. An additional CT scan of the abdomen demonstrated multiple low-density masses of variable size in the both lobes of the liver suggestive of metastasis. A hepatobiliary ultrasound examination showed variable sized hypoechoic masses in the both lobes of the liver. Upper endoscopy and colonoscopy were performed to evaluate the primary origin of metastasis; the findings showed gastritis and colon diverticulum. An ultrasound-guided fine needle biopsy of the liver masses was performed to enable a definite diagnosis of multiple hepatic masses.
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