Wilhelm, Jennifer

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The Medicine ForumVolume 3 Article 122001Photo EssayJennifer WilhelmThomas Jefferson UniversityFollow this and additional works at: http://jdc.jefferson.edu/tmfLet us know how access to this document benefits youThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andinterested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion inThe Medicine Forum by an authorized administrator of the Jefferson Digital Commons. For more information, please contact:JeffersonDigitalCommons@jefferson.edu.Recommended CitationWilhelm, Jennifer (2001) "Photo Essay," The Medicine Forum: Vol. 3, Article 12.Available at: http://jdc.jefferson.edu/tmf/vol3/iss1/12A 42 year-old African American female with no past medicalhistory presented to Methodist Hospital emergency roomwith a chief complaint of increasing abdominal girth anddiscomfort. She reported two months of colicky type painsthroughout her abdomen but no nausea, vomiting, or changein bowel habits. She had missed her last two menstrual cyclesand felt that the protuberance of her abdomen was possiblydue to pregnancy. She requested a pregnancy test.Physical exam was remarkable for a distended abdomenwith liver margin palpated two centimeters below theumbilicus. A pregnancy test was negative. Routinelaboratory testing including chemistries, CBC, coagulationpanel, and liver function studies were within normal lim-its. The patient subsequently received a CT scan, whichshowed a massively enlarged liver with multiple cysts.Interestingly, the patient had minimal cystic involvementof the kidneys.The patient was transferred to Thomas Jefferson UniversityHospital for laparoscopic marsupialization of the dominant cysts.Polycystic liver disease typically presents in the fourth tofifth decades of life. The cysts are thought to arise from aductal plate malformation in the embryo. Cysts in thekidneys occur in 30 to 50 percent of these patients. The num-ber and size of the cysts increase with increasing age.Remarkably, almost all patients have normal liver function.Photo EssayJennifer Wilhelm, MD, Resident Department of Internal Medicine 1999-20001Wilhelm: Photo EssayPublished by Jefferson Digital Commons, 2001

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