Age: 73.0
Sex: M
Vaccine: COVID19
Symptoms: Imaging procedure abnormal, Inflammation, Jaundice, Liver function test increased, Magnetic resonance cholangiopancreatography
Clinical narrative: Discharge Provider: MD Primary Care Provider: MD Admission Date: 7/6/2022 Discharge Date: Jul 15, 2022  PRESENTING PROBLEM: Liver mass [R16.0]   HOSPITAL COURSE: Patient is a 73-year-old male with history of type 2 diabetes mellitus, hypertension and remote alcohol abuse who presented with abdominal pain and jaundice. Initially, he presented to Hospital, where imaging confirmed multifocal liver mass, and labs showed elevated LFTs.  He was transferred to different Hospital for further workup.   Upon admission, the patient was placed on IV fluids and gastroenterology was consulted. Hepatitis panel was done and returned negative.  IR was consulted for liver biopsy, which was performed on 07/08.  Results returned consistent with hepatocellular carcinoma.  There was initially concern for adrenal nodule on initial imaging.  He had follow-up MRCP as well as noncontrast abdominal CT, both of which confirmed benign etiology of adrenal nodule.  Following admission, he developed cough, sputum production and intermittent fevers.  Initial COVID testing in Hospital was negative, but repeat testing on 7/9 returned positive.  As he was not hypoxemic, he was not felt to be a candidate for Decadron.  Due to his elevated LFTs, he was not appropriate to be given remdesivir.  He was provided treatment with convalescent plasma.   For his newly diagnosed hepatocellular carcinoma, Oncology was consulted.  They recommending outpatient follow-up in clinic to discuss potential treatment options.   Initial imaging showed findings concerning for acute cholecystitis.  Surgical Oncology was consulted for evaluation.  They recommended HIDA scan for further evaluation.  HIDA scan was done on 7/9, and was consistent with acute cholecystitis.  Patient was started on IV Zosyn.  Surgical Oncology did not feel that he was a surgical candidate, and recommended Interventional Radiology for cholecystostomy drain placement.  IR was consulted, and cholecystostomy drain was placed on 7/11. Infectious disease was also consulted and they recommended to continue IV zosyn. Bile cultures have been negative.    CT abdomen, pelvis and thorax with IV contrast was done on 7/13/22 and showed .arge liver mass smilar compared with 7/5/2022. Cholecystostomy drain with decompressed gallbladder and decreased pericholecystic inflammation. No findings suspicious for metastatic disease in the chest. Enlarged prostate with heterogeneous enhancement. This is nonspecific but carcinoma and have increased enhancement on CT. PSA was 4.06. Urology was consulted and they recommended outpatient follow-up with urology in 1-3 months with repeat PSA.    CT did show left adrenal nodule and this was discussed with endocrinology. Endocrinology recommended outpatient aldo:renin screen for primary aldosteronism and 1 mg overnight dexamethasone suppression test. The patient was advised to follow-up with PCP for adrenal nodule and outpatient testing.   On the day of discharge, the patient denied any nausea, vomiting or abdominal pain. He was tolerating diet. No fever or chills. He denied any chest pain or SOB. His vital signs have been stable. His LFTs have improved. The patient was discharged home in stable medical condition