Case presentation

A 64-year-old former smoker presented with right flank pain of 1-month duration, minor haemoptysis and weight loss (10% over the past 12 months). His medical history was remarkable for atrial fibrillation, type 2 diabetes and laparoscopic cholecystectomy (CCE) with peroperative cholangiography for acute calculous cholecystitis 10 months earlier. CT of the chest demonstrated a 56×38 mm spiculated mass in the right costodiaphragmatic recess with transdiaphragmatic infiltration and possible invasion of liver segment 7 (figure 1A,B). Positron emission tomography (PET) revealed increased 18F-fludeoxyglucose uptake in the lesion (figure 1C), without evidence of locoregional or distant metastases, raising concern for malignancy. An ultrasound-guided transthoracic needle biopsy was performed. Pathological examination showed chronic inflammation and fibrosis but no malignant cells. The case was discussed at the multidisciplinary tumour board during which radiological imaging was reviewed. The radiologist now described the presence of multiple calcifications posterior to the right liver lobe, just below the diaphragm and adjacent to the presumed lung mass (figure 2A). MRI of the upper abdomen was …