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Kevin S. Hughes, MD; Donald L. Miller, MD; Ronald Neuman, MD; Paul H. Sugarbaker, MD

Arch Surg. 1988;123(8):1013-1015.

Abstract
• Focal hepatic lesions seen on roentgenologic evaluation of the liver in patients with cancer are usually assumed to be caused by parenchymal metastases. In this report, liver imaging tests showed six patients with filling defects caused by peritoneal carcinoma indenting the liver parenchyma. Extrahepatic tumor deposits were misdiagnosed in all but one of these cases. The roentgenographic characteristics that can assist in the differentiation of intrahepatic and extrahepatic metastases are a lens-shaped defect, a defect adjacent to the hemidiaphragm, and a halo around the liver suggesting peritoneal carcinomatosis. A high index of suspicion for extrahepatic tumor masses causing intrahepatic filling defects may help prevent unnecessary exploratory surgery for treatment of hepatic metastases. Angiography may occasionally be helpful in distinguishing intrahepatic from extrahepatic disease.

(Arch Surg 1988;123:1013-1015)

Author Affiliations
From the Winship Cancer Center, Emory University School of Medicine, Atlanta (Dr Sugarbaker); Diagnostic Radiology and Nuclear Medicine Imaging, National Institutes of Health, Bethesda, Md (Drs Miller and Neuman); and the University of California, Davis Medical Center, Sacramento (Dr Hughes).

Footnotes
Accepted for publication July 23, 1987.

Reprint requests to Winship Cancer Center, 1327 Clifton Rd NE, Atlanta, GA 30322 (Dr Sugarbaker).

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