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Image of the Month—Quiz Case FREE

Myriam Loyo, MD; James L. Guzzo, MD; Ying Wei Lum, MD; Julie A. Freischlag, MD
[+] Author Affiliations

Author Affiliations: Departments of Otolaryngology[[ndash]]Head and Neck Surgery (Dr Loyo) and Surgery (Drs Guzzo, Lum, and Freischlag), The Johns Hopkins University, Baltimore, Maryland.


Section Editor: Carl E. Bredenberg, MD


Arch Surg. 2011;146(3):365. doi:10.1001/archsurg.2011.15-a.
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Published online

A 65-year-old man with a long-standing history of repeated admissions for treatment of recurrent alcoholic pancreatitis presented to the emergency department with increasing epigastric pain after a night of binge alcohol drinking. The patient's history revealed 1 day of mild nausea and sharp upper abdominal pain that radiated through to the back. The patient was afebrile with no hemodynamic instability but had prominent epigastric abdominal tenderness. Laboratory evaluation results showed normal renal and hepatic chemical factors, a lipase level of 1248 U/L, and a drop in the hemoglobin level of 3 g/dL in the past 5 months (to convert lipase to microkatals per liter, multiply by 0.0167; to convert hemoglobin to grams per liter, multiply by 10).

In the emergency department, computed tomography (CT) of the abdomen was performed after intravenous administration of contrast medium (Figure 1). This study demonstrated peripancreatic inflammation compatible with chronic pancreatitis and a new 3.7 × 2.9-cm contrast-enhancing collection near the tail of the pancreas.

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Figure 1.

Computed tomography of the abdomen and pelvis.

Graphic Jump Location

WHAT IS THE DIAGNOSIS?

A.  Pancreatic pseudocyst

B.  Splenic artery pseudoaneurysm

C.  Arteriovenous malformation

D.  Pancreaticoduodenal artery aneurysm

Figures

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Figure 1.

Computed tomography of the abdomen and pelvis.

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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