Case report
Identification
35 year old female.
History of present ilness
Abdominal pain and discomfort of 1 month duration. The pain was mainly in the epigastrium and left hypochondrium. The pain was not radiating and was not associated with aggravating or relieving factors.
Past medical history
2016 and 2018 – Cesarean section.
2022- Roux-en-Y gastric bypass surgery.
Physical exam
Upon abdominal examination, a large, palpable, mobile, non-tender mass was found in the left upper quadrant.
- An etiological investigation was carried out.
- The patient performed an abdominal CT scan.
Images
Abdominal CT scan
(A) Sagittal and (B) coronal non-contrast-enhanced abdominal CT scan images shows a circumscribed nodular lesion, heterogeneous, containing areas with higher density, located on the left hypochondrium, showing proximity to the enteroenteric anastomosis (yellow arrow).
Axial abdominal CT scan images with iodinated contrast administration in arterial phase (A) and portal venous phase (B) shows a circumscribed nodular lesion, heterogeneous, with discreet contrast enhancement on late portal phase, located on the left hypochondrium, showing proximity with the renal parenchyma, spleen and adjacent intestinal loops, without signs of invasion.
3D CT reconstruction
Three-dimensional CT reconstruction of the structures of the abdomen shows a circumscribed nodular lesion (red), located on the left hypochondrium, showing proximity to the left lobe of the liver (orange), left kidney (yellow), spleen (green), without signs of invasion.
- Considering the characteristics of the nodular lesion, an abdominal MRI with gadolinium contrast was performed.
Abdominal MRI
Abdominal MRI Axial images.
(A) T2-weighted shows the presence of circumscribed and heterogeneous mass located on the left hypochondrium with T2-hypointense central component surrounded by T2-hyperintense signal.
(B) Nonenhanced T1-weighted shows predominance of isointense signal of the mass.
Abdominal MRI axial images, (A) post contrast-enhanced T1-weighted and (B) delayed phase contrast-enhanced T1-weighted, shows the presence of circumscribed and heterogeneous mass with heterogeneous increased enhancement on delayed phase of gadolinium contrast, located on the left hypochondrium, showing contact with the renal parenchyma, pancreatic tail and adjacent intestinal loops, without signs of invasion.
Abdominal MRI Coronal images. (A) fat-suppressed T2-weighted and (B) T2-weighted.
The presentation shows a large circumscribed and heterogeneous mass with T2-hypointense central component surrounded by T2-hyperintense signal, located on the left hypochondrium, showing contact with the intestinal loops.
