A HEALTHY 14-month-old girl was referred for evaluation of hepatomegaly found during a physical examination prompted by accidental trauma of her left wrist. She had no history of jaundice, weight loss, night sweats, fever, or decreased activity. Her medical history was negative for perinatal difficulties, including cardiac abnormality. There was no recent foreign travel, and the family had no pets. The family history was negative for hepatitis, Wilson disease, α1-antitrypsin deficiency, storage diseases, or hepatic tumors.
Findings from physical examination revealed a well-developed infant with height and weight in the 50th percentile. Heart rate, blood pressure, and respiratory rate were normal, as were the retinae on funduscopic examination. No cutaneous lesions or cardiac murmur were present. The liver extended 5 cm to 6 cm below the right costal margin. The spleen was not palpable. The stool was negative for occult blood. Results of laboratory examination showed reference values for hemoglobin, hematocrit, platelet count, white blood cell count, erythrocyte sedimentation rate, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, γ-glutamyltranspeptidase, bilirubin, and albumin. Abdominal ultrasonogram and computed tomographic scan (with and without intravenous contrast medium) were obtained (Figure 1 and Figure 2). Serum α1-fetoprotein levels were normal. A radiolabeled red blood cell scan was unhelpful for diagnosis because of technical difficulties. Repeated ultrasonography and computed tomography were performed 6 months later with no change seen.
Bishop PR, Nowicki MJ, Parker PH. Radiological Case of the Month. Arch Pediatr Adolesc Med. 2000;154(7):743. doi:10.1001/archpedi.154.7.743