Beware the person with the glass eye and the large liver

Abstract

A 67-year-old woman presented to the emergency department reporting of epigastric fullness, fatigue and weight loss. Physical examination revealed three fingerbreadths of hepatomegaly. Blood tests were unremarkable, save for a moderately raised erythrocyte sedimentation rate. An urgent CT of her abdomen demonstrated two large liver lesions of low attenuation on the non-enhanced scan, showing heterogeneous enhancement in the arterial phase with contrast washout after a 5 min delay, an appearance typical of hypervascular metastasis. Ultrasound-guided biopsy of one of these lesions was performed as a primary tumour was not identified. This revealed metastatic melanoma, however the primary lesion was not apparent on clinical examination.