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Radiological Reasoning: Multiple Hepatic Masses in an Infant

Douglas C. Rivard1 and Lisa H. Lowe1

1 Both authors: Department of Radiology, Children's Mercy Hospitals and Clinics and the University of Missouri–Kansas City, 2401 Gillham Rd., Kansas City, MO 64108.


Figure 1
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  		Fig. 1A —Metastatic neuroblastoma in 4.5-month-old boy with hepatomegaly. Transverse sonogram of abdomen shows enlarged liver infiltrated with multiple heterogeneous masses of varying echogenicity.

 

Figure 2
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  		Fig. 1B —Metastatic neuroblastoma in 4.5-month-old boy with hepatomegaly. Coronal contrast-enhanced CT scan shows heterogeneously enhancing masses in enlarged liver. Also note subcutaneous nodule over right abdomen (arrow).

 

Figure 3
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  		Fig. 1C —Metastatic neuroblastoma in 4.5-month-old boy with hepatomegaly. Axial contrast-enhanced T1-weighted MR image reveals innumerable masses in liver with varying degrees of enhancement.

 

Figure 4
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  		Fig. 2A —Companion case. Multiple hepatic hemangiomas (hemangiomatosis) in 2-month-old boy with hepatomegaly. Axial unenhanced CT image reveals numerous low-attenuation areas scattered throughout liver.

 

Figure 5
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  		Fig. 2B —Companion case. Multiple hepatic hemangiomas (hemangiomatosis) in 2-month-old boy with hepatomegaly. Axial contrast-enhanced CT scan shows vigorous homogeneous enhancement of lesions, confirming their vascular nature.

 

Figure 6
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  		Fig. 3 —Companion case. Hemangioendothelioma in 2-year-old boy with hepatomegaly. Axial contrast-enhanced CT scan shows large mass in right lobe of liver with scattered calcifications (arrows); thick rind of heterogeneous, mostly peripheral enhancement; and central necrosis.

 

Figure 7
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  		Fig. 4A —Companion case. Angiosarcoma in 2-year-old girl with hepatomegaly. Transverse contrast-enhanced CT scan shows poorly defined, heterogeneously enhancing mass.

 

Figure 8
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  		Fig. 4B —Companion case. Angiosarcoma in 2-year-old girl with hepatomegaly. Axial fat-suppressed contrast-enhanced T1-weighted MR image confirms infiltrative enhancing right hepatic mass in liver. Several other similar-appearing hepatic lesions were also found in liver (not shown).

 

Figure 9
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  		Fig. 5 —Companion case. Metastatic Wilms' tumor in 4-year-old boy. Axial contrast-enhanced CT scan shows multiple, variably sized, low-attenuation masses (arrowheads) scattered throughout liver. Primary exophytic hetero geneous left renal Wilms' tumor (arrow) is also noted.

 

Figure 10
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  		Fig. 6A —Companion case. Mycobacterium avium-intracellulare infection in 8-year-old boy with fever and abdominal pain. Axial contrast-enhanced CT scan shows multiple low-attenuation lesions (arrow) in liver and additional low-attenuation focus (arrowhead) in spleen.

 

Figure 11
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  		Fig. 6B —Companion case. Mycobacterium avium-intracellulare infection in 8-year-old boy with fever and abdominal pain. Axial contrast-enhanced CT scan using bone algorithm shows isolated destructive lesion (arrow) of right posterior seventh rib.

 

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