RUQ US: 58 yo WM w/ constipation, elevated liver enzymes. Afebrile

Additional images, same patient. Findings & DDx?
Liver Metastases (Calcified)

• First set of images showed multiple, hyperechoic liver lesions with hyperechoic halos (“target” or bullseye lesions-typically malignant)
• Second set of images shows clean shadowing, c/w calcification in the lesions
• DDx: metastases, HCC, lymphoma, and abscess. Metastases are the most common cause of a calcified liver tumor, and colorectal CA is the most common met to calcify (c/w Hx of constipation)

CT Correlation

• - Metastases are the most common malignant lesion of the liver:
  Colon> stomach> pancreas > breast > lung
• -Most any metastases can calcify, but the most common is mucinous cystadenocarcinoma.
  "COBS": Colon, Ovarian, Breast and Stomach
• -> 4 lesions excludes from resection ("metastatectomy").