Last Week's Medical Mystery
You are practicing Telemedicine and are shown a picture of the abdomen of a
55-year-old man. You are also given a recording taken over his right upper quadrant.
You are given no other information.
DIAGNOSIS: Metastatic cancer of the liver.
The liver is the largest organ in the body and the most frequent organ to be
the target of cancer metastases. This includes cancers of the lung, breast, prostate,
pancreas, colon, rectum, cervix, uterus, thyroid, esophagus, gall bladder and urinary
bladder. The reasons for this predisposition are complex but include the presence
of a highly permeable arterial and venous vasculature and a celluar environment that
is hospitable to tumor cell seeding and growth1. As in the presented case, faint systolic, diastolic, or sytolic-diastolic bruits
may be heard over vascular tumors (see below).
A.
B.
.
A. Livers that are seen protruding dorsally (anteriorly) below the right costal margin are invariably being replaced by tumor. This patient's liver is home to metastatic adenocarcinoma of the colon. B. Vascular tumors may emit very faint systolic and/or diastic bruits. Occassionally, systolic rubs may be heard when tumors outgrow their bloodr supply, infarct, and cause inflammation of the overlying peritoneum. In the presented case, a systolic bruit is heard over the liver.
1. Mielgo, A., Schmid, M.C. Liver tropism in cancer: the hepatic metastatic niche. Cold Spring Harb Prespect Med 2020; 10:a037259.