Ring enhancing liver lesions - good case !

Contributed by: Ed Boas

59 year old woman presents with abdominal pain and night sweats.  CT shows numerous rim enhancing lesions throughout the liver.  This appearance is more commonly seen with metastases, and not abscesses.  Liver biopsy showed metastatic neuroendocrine tumor.  This CT, and an octreotide scan (not shown) did not show the primary tumor.  The fluid collection at the tail of the pancreas resolved on follow up, and is likely a pseudocyst.

There are also descending colon diverticula with surrounding phlegmon, consistent with diverticulitis.

Pearl:

Multiple ring enhancing lesions in the liver are likely metastases, and not abscesses.

Related case:

Reference:

Nino-Murcia M et al.  "Focal liver lesions: Pattern-based classification scheme for enhancement at arterial phase CT."  Radiology 215: 746-51.