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1 s2.0 S0016508511010341 Main
1 s2.0 S0016508511010341 Main
Question: A 63-year-old man with a long-standing medical history of anemia presented to the gastroenterology outpatient clinic
with diffuse abdominal pain, progressive dragging sensation in the left upper quadrant, and marked dizziness. Other prominent
clinical symptoms included a weight loss of 15 lbs over 2 months, anorexia, and intermittent constipation. Clinical examination
revealed tenderness in the left upper quadrant and massive splenomegaly. On further palpation, the spleen extended to the
umbilicus, and had a smooth surface and a very firm consistency. The patient was hemodynamically stable with an arterial blood
pressure of 111/56 mmHg and a heart rate of 90 beats/min. A complete blood cell count showed anemia (hemoglobin, 5.7 g/dL)
and a normal platelet count. No abnormalities were found on the hemogram on a peripheral blood smear. After initial resuscitation,
malignancy screenings, abdominal ultrasonography and computed tomography were performed. Ultrasonographic examination
showed a large heterogeneous mass pattern measuring 30 cm (Figure A). The liver was mildly enlarged with no dilated intrahepatic
ducts. Subsequent abdominal computed tomography confirmed the ultrasonographic findings (Figure B) and further revealed
coarse calcifications, hypodense areas, and enhancing septations (Figure C).
What is the diagnosis?
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Clinical Challenges and Images in GI.
Conicts of interest: The authors disclose no conicts.
2012 by the AGA Institute
0016-5085/$36.00
doi:10.1053/j.gastro.2011.03.067
e24