Cholelithiasis and complicated chronic pancreatitis mimicking malignancy

Marian Smoczyński, Mateusz Jagielski, Michał Studniarek, Joanna Pieńkowska, Krystian Adrych
2016 Polish Archives of Internal Medicine  
CLINICAL IMAGE Cholelithiasis and complicated chronic pancreatitis mimicking malignancy 193 hospitalization, contrast-enhanced computed tomography (CECT) of the abdomen revealed innumerable hepatic focal lesions, intraluminal malignant lesions in the common bile duct (CBD), chronic pancreatitis with pancreatic body fluid collection, and enlarged local lymph nodes around the portal vein, around the common hepatic artery, and in the retroperitoneal space (FIGURE 1A-C). Following the discussion of
more » ... g the discussion of the CECT images during surgical and radiological case conferences, a differential diagnosis of metastatic cholangiocarcinoma versus metastatic intraductal papillary mucinous neoplasm type I was made. Endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) were recommended to establish a definite diagnosis. During EUS, a central walled-off pancreatic necrosis (WOPN) was recognized, for which transmural drainage was performed (FIGURE 1D). After 8 days of active drainage, nasal drain was removed and ERCP was performed to visualize a dilated CBD with numerous gallstones (FIGURE 1E ), partial disruption, and stricture of the main pancreatic A 68-year-old female patient was admitted to our department for the diagnosis of hepatic focal lesions discovered on conventional ultrasound. The ultrasound was performed for acute exacerbation of recurrent abdominal pain, which the patient had been experiencing for the previous 10 years. On admission, the patient complained of generalized weakness and a weight loss of 10 kg over the previous 6 months. Laboratory blood tests showed elevated levels of inflammatory markers, cholestasis parameters, and tumor markers
doi:10.20452/pamw.3294 pmid:26882896 fatcat:jbxyib5pnjcj7hqqcdit46ir2i