Approach to hepatic masses Quiz: Ace Your Exams
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A 43-year-old woman presents to the emergency department (ED) with generalized abdominal pain for the past week. She started noticing yellowing of the eyes two months ago and it has been progressively worsening. She has had an 11.3 kg (25 lb.) unintentional weight loss during the past two months. Temperature is 36°C (96.8°F), heart rate is 76/min, blood pressure is 110/72 mmHg, and respiratory rate is 14/min. Physical examination reveals bilateral scleral icterus, jaundice of the face and extremities, mild abdominal distention, mild diffuse abdominal tenderness, and ascites. Laboratory studies show an alpha-fetoprotein of 410 ng/mL. Abdominal and pelvic CT (computed tomography) with contrast shows a 4.5 cm solid hypodense mass that enhances arterial contrast phase with central washout on delayed contrast phase. Which of the following historical elements, if present, would be most consistent with the likely underlying diagnosis?
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