Case 342

Woman, 13 years old, looked for medical assistance because of abdominal increasing volume, starting about 6 months ago. Her family suspect of pregnancy. At physical examination: skinny, weight: 30kg (zscore – 2.4), height: 1,54 m (zscore -0.6), anicteric; restrictive respiratory pattern (RR: 22bpm) and abolished breath sound at the base of the right hemithorax. Big abdominal mass without defined limits, petreous consistence without pain on palpation, associated to collateral circulation since upper abdominal level to the neck. Laboratorial exams: diminished levels of albumin and hemoglobin; high levels of gamma glutamyl transferase, alkaline phosphatase and lactate dehydrogenase; normal levels of transaminases, bilirubin, sorologys, alpha fetoprotein and beta hCG. An abdominal ultrasonography confirmed the suspect of a liver mass.

Image 1: Chest simple radiography, anteroposterior view (AP).

Image 2: Chest and abdominal computed tomography (CT), before and after intravenous injection of iodinated contrast medium, axial slices. Non-contrast-enhanced phase (A and B). Post-contrast phase: portal (C) and balance (D).

Image 3: Chest and abdominal magnetic resonance (MR), before and after intravenous injection of gadolinium. Non-contrast-enhanced phase, T2 weighted image, axial plane (E). Portal phase, T1 weighted image, axial plane (F) and coronal plane (G).