A Patient with Liver Lesions

Renzo A. Moreno Macedo, MD

doi:10.67223/e0b299a3

Spot the DiagnosisDOI: 10.67223/e0b299a3

A Patient with Liver Lesions

Renzo A. Moreno Macedo, MD
School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
Department of Internal Medicine, La Clínica Anglo Americana, Lima, Peru

Volume 1, Issue 1, Article 6 | Published September 2026 | Submitted June 2026

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Abstract

A 57-year-old woman presented to the emergency department with one week of cough and subjective fever. Chest imaging showed no pulmonary abnormalities, but multiple liver lesions were incidentally identified. She had no abdominal pain or gastrointestinal symptoms, and liver chemistry tests were normal. The imaging findings are most consistent with which diagnosis?

Clinical Vignette

A 57-year-old woman presented to the emergency department with one week of cough and subjective fever. Review of systems was otherwise negative. A chest radiograph, followed by computed tomography (CT) of the chest to clarify a potential lesion, showed no pulmonary abnormalities. However, multiple liver lesions were incidentally identified (Figure 1). The patient had no abdominal pain or gastrointestinal symptoms; liver chemistry tests were normal.

Figure 1. Axial imaging demonstrates numerous small, diffusely distributed hepatic lesions. (A) Non-contrast CT image demonstrating numerous hypoattenuating hepatic lesions. (B) T2-weighted magnetic resonance imaging (MRI) with diffuse, nodular and cystic, homogeneous (without internal septations or mural components) hyperintense hepatic lesions (up to 19 mm) without enhancement on subsequent (C) post-contrast T1-weighted MRI images, which also did not reveal clear communication with the primary biliary tree or biliary ductal dilatation. No restricted diffusion was observed when correlating (D) diffusion-weighted imaging (DWI) with (E) apparent diffusion coefficient (ADC) maps. — **Figure 1**. Axial imaging demonstrates numerous small, diffusely distributed hepatic lesions. **(A)** Non-contrast CT image demonstrating numerous hypoattenuating hepatic lesions. **(B)** T2-weighted magnetic resonance imaging (MRI) with diffuse, nodular and cystic, homogeneous (without internal septations or mural components) hyperintense hepatic lesions (up to 19 mm) without enhancement on subsequent **(C)** post-contrast T1-weighted MRI images, which also did not reveal clear communication with the primary biliary tree or biliary ductal dilatation. No restricted diffusion was observed when correlating **(D)** diffusion-weighted imaging (DWI) with **(E)** apparent diffusion coefficient (ADC) maps.

The imaging findings are most consistent with which of the following diagnoses?

References (5)

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