– 7 year old MN DSH ADR and weight loss
– bloodwork elevated ALT, hyperbilirubunemia, mild neutrophilia, normal HCT
– evidence of EHBDO on ultrasound; pancreas enlarged and hypoechoic
– GB and CBD wall thickened (ddx cholangiohepatitis) ; evidence of IBD vs lymphoma on u/s
– no distinct masses or choleliths seen
DDx: EHBD obstruction due to pancreatiitis/triaditis
The duodenal papilla looks enlarged and swollen to me – is this likely just inflammation or could there be a mass brewing here?
– 7 year old MN DSH ADR and weight loss
– bloodwork elevated ALT, hyperbilirubunemia, mild neutrophilia, normal HCT
– evidence of EHBDO on ultrasound; pancreas enlarged and hypoechoic
– GB and CBD wall thickened (ddx cholangiohepatitis) ; evidence of IBD vs lymphoma on u/s
– no distinct masses or choleliths seen
DDx: EHBD obstruction due to pancreatiitis/triaditis
The duodenal papilla looks enlarged and swollen to me – is this likely just inflammation or could there be a mass brewing here?
Comments
This is ehbdo and the last cm
This is ehbdo and the last cm of the cbd at the d-pap is echogenic (small arrow) and thickened stricturing the dilated proximal cbd (large arrow). Chronic inflammatory cb changes and stricture but biliary carcinoma also possible. Needs cholecystoduodenostomy and that region cut out and inspect the liver closely for anything that can be a met because biliary carcinoma on US can be isoechoic in the parenchyma… I’ve missed those mets more than anythign else in my career.
Thanks. What’s your opinion
Thanks. What’s your opinion on medical management of these?
you can try single dose
you can try single dose dexamethasone 1/4 mg/kg and see if it helps with sonogram Q 24 horus for a few days and bili should be dropping if it works and the lesion is not neoplastic or a fixed tissue obstruction. But this usually only works when there is an ective inflammatory stricture which im not seeing here… this one needs bile duct deviation. Cover with baytril metro as well of course… its shotgun tx
you can try single dose
you can try single dose dexamethasone 1/4 mg/kg and see if it helps with sonogram Q 24 horus for a few days and bili should be dropping if it works and the lesion is not neoplastic or a fixed tissue obstruction. But this usually only works when there is an ective inflammatory stricture which im not seeing here… this one needs bile duct deviation. Cover with baytril metro as well of course… its shotgun tx