A 37-year-old Greek woman presented for a routine "check up" physical examination. Her past medical history included mitral valve prolapse, an episode of herpes zoster of the first branch of the left trigeminal nerve, and a cyst in the left ovary, which did not need surgical removal. She did not complain of any symptoms.

Physical examination revealed a systolic murmur over the mitral area with intensity 2 out of 6, which was attributed to the known mitral valve prolapse. Deep palpation of the right upper abdominal quadrant caused mild discomfort and pain to the patient. The rest of the physical examination was normal.

Routine laboratory testing, including complete blood cell count, serum glucose, creatinine, total lipids, cholesterol, triglycerides, alanine animotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), iron, ferritin and thyroid hormones (T3, T4, TSH) did not reveal any abnormal findings. There was a slightly elevated erythrocyte sedimentation rate (ESR) [26 mm/first hour (normal values less than 20)]. The finding of the right upper abdominal quadrant tenderness was further investigated with an ultrasound (U/S) examination, which revealed a well-circumscribed mass, with mixed echographic pattern, in the right hepatic lobe. A contrast enhanced CT of the abdomen was subsequently performed (Figures 1 and 2).

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