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Liver Metastases : Clinical Features

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Clinical Features: Hepatic metastases are often clinically silent. The symptoms, when present, are those of the primary tumor. They can cause malaise, anorexia, weight loss, and abdominal pain. Obstructive jaundice is rare and is caused by obstruction of large bile ducts or compression of extrahepatic biliary tree by tumor or enlarged perihilar lymph nodes. Some patients present with fulminant hepatic failure due to diffuse replacement of liver parenchyma by metastases. Liver may be enlarged and have irregular, umbilicated surface which may be palpable by the examiner. A friction rub may be heard over the metastases.

Diagnosis: In the appropriate clinical context, the diagnosis of liver metastases can be suspected on imaging studies. Multiphase helical CT and CT during arterial portography are quite sensitive. Dynamic contrast-enhanced Doppler US, T1-weighted MRI, and FDG PET-CT are additional modalities that are useful. Final diagnosis requires an adequate FNA specimen and needle core biopsies obtained under imaging guidance.

This photographs shows a slice of liver with extensive metastases from invasive ductal carcinoma of breast, status-post mastectomy and failed chemotherapy.

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