Friday, April 3, 2009

Sudo III

A 30 year old woman presents with vague abdominal discomfort. Several weeks ago, she started having episodic right upper quadrant pain that was worst after eating, especially ice cream. This pain lasted for several hours. However, a few days later, she got acute onset unrelenting steady mid-epigastric pain. It was band-like and went to her back. She had a lot of nausea, vomiting, and anxiety; the only thing that made it better was leaning forward. She was admitted to the hospital for several days but does not remember what the diagnosis was.

Now, weeks after that initial disease, she has abdominal discomfort, so you get a CT:

Challenge: What is it?

Image shown under fair use.


Alex said...

Pseudocyst but could also work her up for pseudoobstruction

Craig Chen said...

Sudo III

This is a pancreatic pseudocyst, a fluid collection >4 weeks old with a defined wall of reactive granulation tissue around a maturing collection of pancreatic juice. They occur after 10% of episodes of acute pancreatitis; necrosis of peripancreatic tissue progresses to liquefaction and subsequent organization and evolution into a pseudocyst. Trauma may also cause pseudocysts.

Source: UpToDate; original picture by Jonathan Kruskal.