Endgames Picture quiz

A case of hepatomegaly

BMJ 2008; 337 doi: http://dx.doi.org/10.1136/bmj.a3090 (Published 30 December 2008) Cite this as: BMJ 2008;337:a3090
  1. Dushan Thavarajah, specialist trainee year 1, general surgery1,
  2. Srilekha Attavar, specialist registrar year 5, general surgery 1,
  3. Jay Menon, consultant general and vascular surgeon 1
  1. 1Basildon University Hospital, Basildon SS16 5NL
  1. dushanthavarajah{at}yahoo.com

    A 27 year old man from Turkey presented with sudden onset epigastric pain that woke him from sleep. He had no other symptoms. On examination he had right upper quadrant abdominal tenderness and a palpable hepatomegaly of 10 cm below the right subcostal margin. Blood results showed a white cell count of 12.6×109 cells/l and C reactive protein of 366 μg/ml, and liver function was normal.


    • 1 Describe the abnormalities in the figures

    • 2 What is the likely diagnosis?

    • 3 How would you establish the diagnosis?

    • 4 What is the treatment?

    Fig 1 Ultrasound scan (top) and computed tomograms

    Short answers

    • 1 The ultrasound scan of the liver (top), shows a multicystic, multiloculated mass of …

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