Can we guess the primary site with the liver secondary appearance ?


This was 61 year old gentleman ,who came for complaints of  right upper quadrant pain , poor appetite for the past 1 month. He also gave history of tenesmus later in the day ( after a normal evacuation in the mornings ) . There was no history of any malaena.

His liver showed multiple secondaries .

secondaries show target appearance or bird's eye view of mexican hat appearance

secondaries show target appearance or bird’s eye view of mexican hat appearance

LIVER SEC _2

LIVER SEC _4

LIVER SEC _5

glass body 4d view

glass body 4d view

pancreas and spleen appeared to be normal

pancreas and spleen appeared to be normal

his right kidney appeared to be shrunk

his right kidney appeared to be shrunk

his left kidney appeared to be normal

his left kidney appeared to be normal

power doppler showed reduced flow in the right kidney

power doppler showed reduced flow in the right kidney

Clinically he had uncontrolled systemic hypertension and mildly elevated s. creatinine of 1.7 mgms/dl.

The diagnosis offered was multiple liver secondaries with incidental finding of shrunk right kidney with probable reduced function.

DISCUSSION : Generally the target sign or the bird’s eye view of the Mexican hat sign could signify colo-rectal carcinoma.

mexican hat birds eyw view

Further investigations revealed normal upper G.I. Endoscopy .

Colonoscopy revealed  Carcinoma of Rectum with no obstruction.

IMG_0911

He has been advised chemo-radio therapy by the surgeon.

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