We report the case of a 45-year-old male soldier who was evaluated for a rapidly expanding hepatic mass following cholecystectomy and was eventually found to have isolated polycystic liver disease and express HFE H63D homozygosity. Both H63D homozygosity and isolated polycystic liver disease are only rarely associated with clinical cirrhosis. This is the first reported case of their concomitant presentation.

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Purpose – To compare overall number of downstream tests and total costs between initial exercise stress echocardiography (ESE) or cardiac computed tomography angiography (CCTA) in symptomatic, low to intermediate risk patients suspected of having coronary artery disease (CAD). Methods – This is a retrospective cohort study which initially screened 11,636 symptomatic patients without known CAD who underwent noninvasive evaluation between 2008–2014. Of these, and after applying prespecified exclusion criteria, 1,612 underwent ESE or CCTA. A total of 651 patients were included after performing propensity-matching for known risk factors for CAD. The total number of additional downstream tests over the next five years was determined. The total costs associated with each arm, inclusive of the initial test and all subsequent tests, was calculated using the 2018 Medicare Physician Fee Schedule. Results – 18.5 percent of patients with a normal ESE result underwent some additional form of cardiac testing over the five years after initial testing compared to 12.8 percent of patients with a normal CCTA. The absolute difference in total number of downstream tests between both study groups was 5.7 percent (p = 0.03). When factoring the costs of the initial test as well as the downstream tests, the ESE group was associated with overall lower costs compared to the CCTA group, 351 United States Dollars (USD) versus 496 USD (p < 0.0001). Conclusion – This study demonstrates that, when compared to CCTA, ESE is associated with a higher total number of downstream tests, but overall lower total costs when chosen as initial testing strategy for suspected CAD.

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