Fig. 13

A 44-year-old male, previously healthy professional gardener on the island of Martha’s Vineyard, now presenting with cutaneous ulcer and lymphadenopathy on his arm, right upper quadrant pain, fever, and malaise. He was referred to MRI for a mass within the liver detected on abdominal US. Axial plane postcontrast image demonstrates an avidly enhancing, predominantly solid mass (arrows) adjacent to inferior vena cava and the caudate lobe. Acute titers for tularemia were elevated. Titers normalized and the lesion almost completely resolved on follow up MRI after doxycycline treatment