-Something simple for a change: “65 year old female with abdominal pain. Came for CT scan at my practice. This is a coronal re-construction of the CT.
Your findings & diagnosis please
Seelan
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News, Views and More from Batch'64, Faculty of Medicine, Colombo, SriLanka
"Best and the Brightest from 1964"
News, Views and More from Batch'64, Faculty of Medicine, Colombo, SriLanka 
Multiple abscesses due to infection perforation due to a foreign body?
I tried
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Multiple abscesses due to infection and perforation due to foreign body?
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Past history includes Lymphoma & coronary cardiac events & TIA
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Ovarian cancer with spread to the peritoneum.
Nisantha
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I would agree with Nisantha. Metastatic Ovarian Cancer,, with spread all over.
WIMAL
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Dear Wimal,
Nice to hear from you. How are you & Iranthie keeping? We are just kicking on!
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Can I have another wild guess, pancreatic lymphoma?
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Discussion:-
Rani’s case of “Broken Heart Syndrome” prompted me to put this case up.
Patient was referred to us for CT of abdomen with a history of abdominal pain. Past history includes Lymphoma in remission, multiple coronary events & TIA.
The CT showed only a simple cyst in the right lobe of liver, proved by ultrasound & nothing else significant within the abdomen & pelvis.
In radiology, we were taught to ‘always look at the corners & edges of the film’.
In this case, there is a filling defect within the left ventricle & another tiny one in the right ventricle. A linier metal seen in the right ventricle is a Pacemaker.
DD of Left Ventricular mass :- Thrombus, Fibroma, Myxoma & vegetation.
In this case,Past history plays an important part in the differentiation. Thrombus can form in the LV in patients with coronary events , LV aneurysm, cardiomyopathy (including Takotsubo broken heart) Myocarditis etc where there is cardiac wall motion abnormality.
This patient also has a history of TIA.
The above are in favour of the filling defect in the heart to be an organised Thrombus.
Echo cardiography is an important investigation. Contrast MRI is used to identify any vascularity (as in tumours)
Diagnosis : Organised Thrombus – an incidental finding but very helpful !
Thank you for participating.
Seelan
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