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A 41-year-old obese, but otherwise healthy man was found on routine blood testing to have a serum ferritin level of greater than 1000 ng/mL (normal ¼ 20 to 380). A bone marrow biopsy was unremarkable. He was diagnosed with hemochromatosis and was treated with phlebotomy for several years. He was free of symptoms until the age of 46, when he noticed a ''lump'' in his chest. Chest X ray and a magnetic resonance imaging (MRI) revealed a sternal mass, which was biopsied and revealed a B-cell lymphoma. The patient underwent chemotherapy with a regimen of cyclophosphamide, hydroxydaunorubicin, Oncovin 1 , and prednisone (CHOP), as well as Rituximab and radiation therapy.This resulted in marked shrinking of the sternal mass. He was followed with routine computed tomography (CT) and positron emission tomography (PET) scans. Six months after completing treatment, he had a repeat biopsy of his chest wall that was negative for malignancy.On a subsequent routine follow-up CT scan about 8 months prior to his most recent admission, a 3 cm mass was noted in the right lobe of the liver along with several preexisting cystic structures (Fig. 1). A PET scan 2 months later revealed increased uptake in the midportion of the right lobe of the liver abutting on the lateral chest wall. This lesion corresponded to the hyperdense lesion seen on CT scan, which was biopsied. Histological examination was reported to ''favor malignant epithelial neoplasm.'' Liver function tests and tumor markers (alpha fetoprotein, carcinoembryonic antigen, and carbohydrate antigen 19-9) were normal.Following this diagnosis, he was referred for further work-up, including upper and lower endoscopies. Additional laboratory findings at that time showed a serum iron of 52 ug/dL (normal ¼ 40 to 190), total ironbinding capacity of 305 ug/dL (normal ¼ 250 to 440), transferrin saturation of 17% (normal ¼ 15 to 50), ferritin of 67 ng/mL (normal ¼ 20 to 380), serum transferrin of 227 mg/dL (normal ¼ 188 to 341), prothrombin time of 13.3 seconds (normal ¼ 11.5 to 14.5), and negative serological studies for hepatitis B and C. The patient was also found to be heterozygous for both the C282Y and H63D mutations of the hemochromatosis (HFE) gene.A nonanatomic resection of the mass in the right lobe of liver was performed. There were two liver cysts, one in segment VII and one in the left lateral segment, which were not excised. Dense adhesions of the liver to the anterior chest wall and diaphragm were noted, likely because of prior radiation therapy. DIFFERENTIAL DIAGNOSISThe differential diagnosis of an adult man with a new hyperenhancing lesion in the liver presents a diagnostic challenge that is best approached from a radiological perspective. Although the number of possibilities is fairly limited, the spectrum includes both benign and malignant neoplasms. By far the most common lesion is a hemangioma. This benign neoplasm of vascular origin is Alcohol and Alcoholic Liver

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