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Special Feature |

Image of the Month—Quiz Case FREE

Rabih M. Salloum, MD; Leonidas Koniaris, MD
[+] Author Affiliations

Section Editor: Grace S. Rozycki, MD

Arch Surg. 2004;139(4):449. doi:10.1001/archsurg.139.4.449.
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A 75-year-old man with a history of type 2 diabetes mellitus, hypertension, and depression sought care at the emergency department with a 5-day history of generalized itching and malaise. At physical examination, the patient was slightly anxious but in no acute distress; his sclera were icteric, and his abdomen was soft, with slight fullness in the right upper quadrant but no discrete masses or tenderness. Laboratory test results demonstrated a white blood cell count of 13 500 cells per microliter (13.5 × 10− 9L) but his electrolyte level was normal. His total serum bilirubin level was 19.5 mg/dL (333.45 µmol/L), and he had an alkaline phosphatase level of 917 IU/L. A computed tomographic (CT) scan of the abdomen was obtained (Figure 1).

Place holder to copy figure label and caption

Figure 1.

Graphic Jump Location

A.Complex cystic neoplasm

B.Unusual duplication cysts

C.Periampullary tumor

D.Mirizzi syndrome


Place holder to copy figure label and caption

Figure 1.

Graphic Jump Location




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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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