Mass in Right Upper Ouadrant of the Abdomen

Dr. Deborah M. Forrester: This 41-year-old Negro man was transferred from Nassau for evaluation of a mass in the right upper quadrant of the abdomen. The patient had been well until three months prior to admission when he noted intermittent pain in the right upper quadrant which radiated to the back. He had lost 11.3 kg (25 lb). Two days prior to admission, he had a temperature of 102 F (38.9 C). There was no history of jaundice, heavy alcoholic intake, parasite infestation, or change in the color of urine or stool. The physical examination was within normal limits except for a nontender, firm liver palpable four fingerbreadths below the right costal margin. No ascites or lymphadenopathy was noted. Laboratory data showed elevated sedimentation rate and abnormal liver function. The stool examination revealed no ova or parasites. Discussion Dr. Laurence L. Robbins: Dr. Janower, what is your opinion? Dr. Murray