Presentation
Incidental finding in a CT investigation for abdominal pain; left lower quadrant tender with guarding. Previous history of pancreatitis. Some epigastric tenderness, pancreatitis?
Patient Data
Mild diffuse pancreatic duct dilatation, already identified on previous scans, and 14mm hypodensity in body/tail of the pancreas, stable with no features to suggest acute inflammatory process. Liver has heterogeneous enhancement likely perfusional/hepatic venous congestion, no focal lesions identified.
The spleen and adrenal glands are normal. Kidneys are malrotated and asymmetric due to a atrophic left kidney; no hydronephrosis.
Gallbladder wall seen with no calculi visible. No bile duct dilatation ( CBD measures 5 mm ).
The liver is unremarkable in appearance. The pancreatic body/tail lesion could not be well evaluated.
Case Discussion
This case illustrates a mottled appearance of liver enhancement in the portal venous phase due to a cardiac congestive failure. This appearance is known as nutmeg liver.
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