Case 339

History A 66-year-old male patient with a background history of hypertension and no history of liver disease was found to have mildly deranged liver function test results as part of his annual hypertension review. Clinical examination findings were unremarkable, the patient was afebrile (36.8 °C), and other vital observations were within normal limits. Full blood count and urea and creatinine levels were within normal limits; however, liver function tests revealed a mildly elevated alanine aminotransferase level of 61 IU/L (1.02 µkat/L) (reference range, 0–40 IU/L [0–0.67 µkat/L]), and a mildly elevated γ-glutamyltransferase level of 52 IU/L (0.88 µkat/L) (reference range, 0–50 IU/L [0–0.83 µkat/L]). The patient subsequently underwent US examination of the abdomen, which revealed a large liver lesion in an otherwise normal liver with no imaging features of cirrhosis. MRI of the liver was performed for further characterization ( Fig 1 ). The patient subsequently underwent resection of the large mass and surgical pathology. Surveillance MRI was performed 4 months after surgery ( Fig 2 ).