Metastatic rectosigmoid cancer with polycystic kidney and liver disease
Presentation
Metastatic work up of a pathologically proven rectosigmoid cancer.
Patient Data
Two hepatic hyperechoic focal lesions with hypoechoic hao (giving target appearance).
An irregular circumferential wall thickening involves the rectosigmoid colon associated with right-sided para-colic soft tissue extension, stranding of the pericolic fat planes, and multiple small regional and left common iliac lymph nodes.
Three hypodense lesions with faint peripheral enhancement are seen at the hepatic segments 6 and 4/8 interface.
Other numerous variable sized lesions with fluid attenuation (representing simple hepatic cysts) are seen scattered in both liver lesions, in keeping with polycystic liver disease.
Both kidneys are also seen as seats of multiple variable sized simple cysts, in keeping with polycystic kidney disease.
Three hypoattenuating lesions with faint marginal enhancement were noted on CT images (arrows), two of them appeared on the ultrasound as hyperechoic lesions with surrounding hypoechoic halo (giving target / Bull's eye sign).
Case Discussion
This patient had a positive family history of autosomal dominant polycystic kidney disease. This was challenging for detecting the hepatic metastatic deposits and discriminating them from the existing hepatic cysts. Relative higher attenuation than the cysts, peripheral marginal enhancement, and target/bull's eye sign on ultrasonography helped to make the diagnosis of metastases.