Hepatic hyperechoic lesion in a young, healthy man

A hyperechoic nodule in the liver has a broad differential; however, the vast majority are benign lesions. We report a case of a 29-year-old man with a history of anxiety and depression who presented to the hospital due to a 12-day history of epigastric pain with radiation to the back, fevers, and night sweats. Initial imaging revealed a small hyperechoic nodule on the liver, originally believed to be an abscess. Image-guided aspiration was attempted but no fluid could be drained. An endoscopic ultrasound was pursued to further evaluate the lesion and obtain a biopsy. An ulcerated esophageal mass was incidentally identified on endoscopy. Hepatic and esophageal biopsies demonstrated moderately differentiated adenocarcinoma, with esophageal adenocarcinoma as the primary source. This case highlights an interesting presentation for the rare occurrence of metastatic esophageal adenocarcinoma in a young, healthy individual without identifiable risk factors.