A Man’s Unexplained Worsening Abdominal Pain: A Case of Hepatic Teratoma
Authors:
Brandon M. Carius, PA-C; Ronald D. Anderson, DO; and Brian K. White, DO
Citation:
Carius BM, Anderson RD, White BK. A man’s unexplained worsening abdominal pain: a case of hepatic teratoma. Consultant. 2017;57(9):550-552.
A 36-year-old man serving in the military presented with persistent right upper quadrant (RUQ) abdominal pain, which initially had been diagnosed as an abdominal strain resulting from heavy lifting approximately 1 month previously. The pain had worsened since then, particularly postprandially, despite empiric trials of omeprazole and behavioral modifications (reducing coffee intake and eliminating alcohol intake).
Ultrasonography (US) was performed (Figure 1), the results of which prompted computed tomography (CT) scanning. CT scans revealed a hepatic cystic structure measuring 19 × 13 × 18 cm, with enclosed daughter cysts measuring up to 5 cm in diameter (Figures 2 and 3). These findings initially were thought to be consistent with hydatid cyst (parasitic infestation by the tapeworm Echinococcus granulosus), given the man’s deployment history to Iraq, and empiric albendazole treatment was started. However, Echinococcus antibody test results returned as negative.
Ultimately, he underwent resection, during which a 2.3-kg mass with 55 secondary cystic structures, each filled with keratinaceous material, was removed (Figures 4 and 5). The mass was noted to have been encroaching upon the common hepatic artery, the gallbladder, and the common bile duct.
NEXT: Discussion
Authors:
Brandon M. Carius, PA-C; Ronald D. Anderson, DO; and Brian K. White, DO
Citation:
Carius BM, Anderson RD, White BK. A man’s unexplained worsening abdominal pain: a case of hepatic teratoma. Consultant. 2017;57(9):550-552.
A 36-year-old man serving in the military presented with persistent right upper quadrant (RUQ) abdominal pain, which initially had been diagnosed as an abdominal strain resulting from heavy lifting approximately 1 month previously. The pain had worsened since then, particularly postprandially, despite empiric trials of omeprazole and behavioral modifications (reducing coffee intake and eliminating alcohol intake).
Ultrasonography (US) was performed (Figure 1), the results of which prompted computed tomography (CT) scanning. CT scans revealed a hepatic cystic structure measuring 19 × 13 × 18 cm, with enclosed daughter cysts measuring up to 5 cm in diameter (Figures 2 and 3). These findings initially were thought to be consistent with hydatid cyst (parasitic infestation by the tapeworm Echinococcus granulosus), given the man’s deployment history to Iraq, and empiric albendazole treatment was started. However, Echinococcus antibody test results returned as negative.
Ultimately, he underwent resection, during which a 2.3-kg mass with 55 secondary cystic structures, each filled with keratinaceous material, was removed (Figures 4 and 5). The mass was noted to have been encroaching upon the common hepatic artery, the gallbladder, and the common bile duct.
