CEUS in a case of fatigue, eosinophilia and abdominal right upper quadrant discomfort

Purpose: We describe the case of a 78 year old german physician who was referred for evaluation of fatigue of 3 months duration, marked eosinophilia of 50%, right upper quadrant discomfort and sligthtly elevated liver function tests in the setting of cholezystolithiasis. Material and methods: We performed EUS, US and CEUS, CECT, liver histology, bone marrow histology and serology Results: Choledocholithiasis was excluded by EUS. US showed a slightly inhomogenous left liver lobe with few subcentrimetric peripheral echopoor areas. CEUS demonstrated peripherally located small hypoenhancing areas in the arterial pha…