case_images: PMC11102091_01
case_images: The timeline of this patient.
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case_images: A 75-year-old man was admitted to hospital with a complaint of blood in his stool that had persisted for 1 month (Figure 1).
case_images: Rectal pathology results before and after the laparoscopic surgery for rectal cancer. (A), The left figure displays the pathological findings of a subtypical polyp measuring 1.8x1 mm and located 15 cm from the anus before the surgery, suggesting a low-grade tubular adenoma (hematoxylin-eosin (HE) staining, 100x). The middle (HE staining, 100x) and right figures (HE staining, 200x) display the pathological findings of a cauliflower-shaped mass visible 8 cm from the anus, suggests high-grade tubular adenoma. (B) The surgical rectal specimens revealed atypical glands with invasive growth in the submucosa, indicating moderately differentiated adenocarcinoma (left panel, HE staining, 100x). The tumor cells of colorectal cancer were strongly positive for carcinoembryonic antigen (CEA) in the cytoplasm (right panel, immunohistochemistry (IHC), 100x).
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case_images: After admission, the patient underwent a colonoscopy and tissue biopsy, which confirmed the diagnosis of rectal cancer (Figure 2A). Postoperative rectal pathological results revealed moderately differentiated adenocarcinoma with strong carcinoembryonic antigen (CEA) positive (Figure 2B).
case_images: Contrast-enhanced CT of the chest showed no obvious filling defect in the pulmonary artery.
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case_images: Enhanced chest and abdominal CT scans reveal no pulmonary embolism (Figure 3).
case_images: Plain scan shows multiple irregular low-density shadows of different sizes in the liver.The larger ones are located under the right lobe capsule with clear boundaries. The blue arrow points to the liver infarction lesion observed on CT plain scan.
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case_images: However, multiple irregularly shaped intrahepatic lesions with decreased liver parenchyma density and no obvious space-occupying effect were observed, raising suspicion for focal hepatic fatty deposition, hepatic abscess, or hepatic infarction (Figure 4).
case_images: The lesion density on enhanced scan showed no obvious enhancement, and the density was significantly lower than that of normal liver parenchyma, with no obvious space-occupying effect. Small blood vessels could be seen in the lesion, and no capsule could be seen (Left figure). Coronal view showing wedge-shaped lesions in the liver (fan-shaped changes) (Right figure). The left blue arrow indicates the liver infarction lesion seen on the axial enhanced CT, while the right blue arrow indicates the liver infarction lesion seen on the coronal view.
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case_images: The lumen of the liver blood supply system (hepatic artery, hepatic vein, and portal vein) appeared thinner and narrower with poor filling after enhanced CT, leading to the diagnosis of hepatic infarction (Figure 5).