Case discussion
01Clinical context
A patient presented with abdominal pain, fever, weight loss, and constitutional symptoms. Prior imaging suggested a hypervascular jejunal mass with multiple liver lesions, raising suspicion for small-bowel gastrointestinal stromal tumor (GIST) with hepatic metastases. Liver biopsy showed inflammatory changes rather than metastases.
02Key imaging findings
Triphasic contrast-enhanced CT shows a well-defined, hypervascular exophytic mass in the proximal jejunum measuring about 5.2 × 4.4 × 5.2 cm with a central air-containing cavity communicating with the jejunal lumen, highly suspicious for GIST. Multiple complex hepatic lesions, dominant in segment IVb (6.8 × 6.6 cm), show multiloculated low attenuation with peripheral and septal enhancement, consistent with multifocal hepatic abscesses rather than metastases. Partial thrombosis of the right portal vein near its branching is present, likely septic (pylephlebitis). No high-grade bowel obstruction or other significant abnormalities.
03Diagnostic reasoning
The diagnosis was reached by triphasic CT imaging demonstrating a hypervascular jejunal mass with a characteristic central air cavity communicating with the bowel lumen, suggestive of GIST. The hepatic lesions showed multiloculated low-attenuation areas with peripheral enhancement, correlating with biopsy-proven abscesses rather than metastases. The presence of partial right portal vein thrombosis adjacent to infected hepatic segments raised suspicion for septic thrombophlebitis (pylephlebitis). The combination of imaging features and histopathology guided the diagnosis and management plan.
04Questions for clinical practice
What is the significance of the central air-containing cavity in the jejunal mass? It suggests communication with the bowel lumen, characteristic of GIST. How to differentiate hepatic abscesses from metastases on imaging? Abscesses often show multiloculated low attenuation with peripheral enhancement and correlate with inflammatory biopsy findings. What is the clinical importance of portal vein thrombosis here? It may represent septic thrombophlebitis requiring prompt management. When should follow-up imaging be performed? After antimicrobial therapy and drainage to assess lesion regression and thrombosis resolution.
05Teaching point
This case highlights the importance of correlating imaging with histopathology in suspected small-bowel GIST with liver lesions. Multifocal hepatic abscesses can mimic metastases on imaging, and portal vein thrombosis may complicate infectious processes. Definitive tissue diagnosis and multidisciplinary management are essential. Image-guided drainage of hepatic abscesses and careful follow-up imaging after antimicrobial therapy are critical for optimal care.
Shown for education. De-identified — no identifiable patient data. A radiology report is a specialist opinion and must be read with the full clinical context by the treating physician.