Diagnostic Dilemma: Metastatic Breast Adenocarcinoma Presenting With a Cholestatic Liver Injury Without Radiological Findings of Liver Metastases

Cholestasis refers to a reduction in bile flow caused by either impaired secretion or obstruction. Cancers may manifest with cholestasis due to metastasis (either obstruction or infiltration), paraneoplastic syndromes, or as a side effect of treatment (chemotherapy, immunotherapy, or radiation). Various imaging techniques, including ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) scans, are typically used to assess the obstruction, its location, and the underlying cause. We are presenting a complex and challenging case of metastatic breast cancer in the liver that presented as cholestatic liver injury without corresponding radiological findings. We aim to highlight the importance of considering liver metastasis as a differential diagnosis, even in the absence of supporting radiological evidence.