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Figure it out fridays 

#56

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57 year old male, who consulted his family doctor for a 2 month history of right upper quadrant pain and fever. He also reported significant weight loss and anorexia. 

On examination:

Febrile but otherwise vitally stable

Abdominal examination: Median incisional hernia, a tender and irregularly shaped mass in the right upper quadrant with local signs of infection

Past medical history: Hypertension and diabetes. 

Past surgical history: 

  • Laparotomy 30 years ago after a road traffic accident. 

  • In 2000, he was operated on for bowel obstruction. 

  • In 2005, he had prosthetic incisional hernia repair (the details of the intervention were not available). 

 

Laboratory: High white cell count and C-reactive protein. 

 

Abdominal USS: An infiltration of mesenteric fat. 

 

CT abdomen: above images 

What is the most likely underlying diagnosis?

A. Tumor 

B. Inflammatory mass

C. Lipoma

D. Hernia

E. Intra-abdominal abscess

 

 

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