Presentation
Extreme weakness, diminished appetite, unintended weight loss. History remarkable for Waldenström macroglobulinemia and hypertrophic obstructive cardiomyopathy
Patient Data
Liver - normal size, coarse echotexture. 2 hypoechoic lesions in right lobe - approximately 4.7 cm and 2.8 cm across, possibly metastases or abscesses.
Cardiac chambers enlarged. Pleural effusion - right minimal, left moderate, both accompanied by passive atelectasis in lung bases.
Liver of normal density, its border serrated, small right lobe. Several tiny hypodense (cystic?) foci in left lobe, most of which appear on previous CT exam two years prior (not shown). Between segments 6 and 7 are two hypodense subcapsular structures measuring ~20 HU with thin wall and septa isoenhancing to liver; the smaller measures 2.4 x 3.2 x 3.2 cm and abuts the right hepatic border, the larger measures 4.8 x 5.2 x 4.4 cm and bulges from the left hepatic border.
Case Discussion
The smaller, more superficial hepatic lesion was aspirated, as was the large splenic lesion, both yielding thick pus. The pus was cultured and grew S. viridans.
The patient underwent splenectomy but deteriorated rapidly in the course of several weeks, and died of septic shock.
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