Clinical presentation:
Adult male with known chronic liver disease with recent adbominal distension and loss of appetite. All images were old enough to have been recorded on photographic paper.

The CT scan shows a dense irregular shrunken liver and a relatively larger and lower density in the mid-line with its centre of radius in the quadrate lobe of liver. The low density involves the medial portion of the left lobe. The appearance is complicated by overranging artifacts from contrast in the stomach. There is the appearance of free fluid in the abdomen.

The ultrasound cut is right para midline and slightly oblique. It shows enlargement of the medial portion of right lobe by a lobulated area of lower echo density. This lesion is not homogeneous and contains areas of lower density. Although these appear vaguely branched, there is no posterior enhancement ot indicate that they contain trans-sonic fluid. The appearance suggests overlapping lower-echo nodules within a single mass, rather than a branching tubular structure. There is no visible free fluid; the clinicians did a drainage procedure shortly before the ultrasound.

The MRI image shows an area of low signal involving the liver, broadly mid-line and extending into the left lobe. A branching stricture of lower density in the left lobe, slightly resembles a dilated tubular structure. The contents might be soft tissue, rather than inspissated bile, (no branching fluid density in the CT scan).