Orbital sarcoma

HISTORY: 21-year-old female with known orbital sarcoma, now with

elevated liver function tests.

 

FINDINGS: Images 1-3 are transverse scans of the liver demonstrating

multiple rounded echogenic masses (arrows) with marked compression of

the portal venous system as seen on Image 3.

Images 4 and 5 are contrast-enhanced spiral CT scans demonstrating

extensive necrosis within both lesions as there is central liquefaction.

DIAGNOSIS: Metastatic sarcoma to the liver.

DISCUSSION: In this patient the right lobe of the liver is virtually

replaced by metastatic lesions.  There is marked compression of the

right portal vein.  Because of a lack of a hepatic contrast agent to

assess parenchymal perfusion, ultrasound is relatively limited in the

diagnosis of tumor necrosis.  On contrast-enhanced CT, note that there

is viable tumor on the periphery of lesions, and central liquefaction

and necrosis.  This is of relevance in performing percutaneous liver

biopsies as only blood and necrotic tissue will be obtained if the

center of the lesion is biopsied.