Case 344

A previously healthy 33-year-old woman presented with several months of intermittent right upper quadrant discomfort, early satiety, bloating, and nausea. She had no remarkable past medical or surgical history, specifically no known malignancy, chronic liver disease, or substance abuse. She had four biologic children and reported no current or prior oral contraceptive use. Physical examination revealed normal vital signs and a soft, nontender abdomen. Laboratory studies included a hepatic function panel, which was normal. Results for serum tumor marker tests included an α-fetoprotein level of 2.1 µg/L (reference range, ≤8.3 µg/L), a carcinoembryonic antigen level less than 0.6 µg/L (reference range, ≤5.0 µg/L), and a cancer antigen 19-9 level of 17.4 kU/L (reference range, ≤35.0 kU/L). A urine pregnancy test was negative. CT of the abdomen and pelvis with intravenous contrast material was performed (Fig 1). No extrahepatic pathologic features were identified. MRI of the abdomen without and with intravenous contrast material was performed, for further evaluation of the liver findings (Fig 2).