Visualization of microscopic metastatic hepatoma to lung on gallium scintigraphy

The author presents a case of metastatic hepatoma diagnosed at autopsy. The patient's liver had been nearly entirely replaced, and there were diffuse microscopic pulmonary metastases. Chest x-ray was normal at the time of gallium imaging for fever of unknown origin. Gallium imaging revealed a normal-appearing liver and mild, diffuse, bilateral increased uptake in the lungs. A CT scan 3 weeks before autopsy showed relatively minimal abnormality of the liver with a few areas of inhomogeneity and mild enhancement with contrast. Ultrasound-guided aspiration and liver biopsy were negative for tumor or infection. No case report or description of microscopic lung metastases from hepatoma seen with gallium was discovered in a recent literature search.