| _creationDate | July 17, 2026 |
| _modificationDate | July 17, 2026 |
| _creator | Si787 |
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|identifier=WSI24-485-Case-1
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|code=apdidactic
|category=409073007
|subject=BWH
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|priority=Routine
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|requisition=
|reasonCode=48-year-ol ... |
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| subject | BWH |
| occurrenceDateTime | July 21, 2026 1:00:00 PM |
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| requester | Lz31 |
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| reasonCode | 48-year-old woman with history of breast cancer (2022 diagnosis • status post resection and chemotherapy finished 2024 • currently on Lupron/Letrozole) • diabetes • BMI 30 • pulmonary valve stenosis • and no alcohol use since 2022 • presenting with abnormal liver enzymes and abnormal liver imaging. Most recent labs (Apr2026) showed AST 32 • ALT • 29 • Alk Phos 147 • tBili 0.5 • albumin 4.6 • and globulin 3.2 • as well as normal ANA • A1 antitrypsin • and mitochondrial M2 Ab. Portal pressure gradient was calculated as 16 mm Hg (consistent with CSPH • with highest HV pressure of 10mmHg and lowest PV pressure of 25mmHg) by EUS. Liver stiffness by EUS elastography ~7kPa left liver • ~13 kPa right liver. Also found small (<5mm) esophageal varices. |
| supportingInfo | Steatohepatitis with prominent centrizonal inflammation • fibrosis • ballooning degeneration and ducular reaction (Grade 2 • Stage 2 of 4)(Brunt Scoring System).
Copper dry weight of <10 mcg/g (reference value of <50) . |
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