A 10-year-old NM DSH was presented for evaluation of acute onset anorexia that showed some response to symptomatic therapy. Abnormalities on CBC and serum biochemistry were neutrophilia and elevated liver enzyme activity (ALT 791, ALP 487, GGT 3) and bilirubin (6.2). Survey radiographs were suspicious for an abdominal mass.
Duodenal mass with regional pancreatitis pattern. Potential concurrent pancreatic neoplasia, post-hepatic obstruction and gastric ileus.
The gallbladder was thickened. The gallbladder was not overly distended, yet a minor amount of echogenic debris and turgid contour was noted. The common bile duct was obstructed at 1.0 cm dilation. Severe gastric dilation with fluid was noted. A mass deriving from the proximal duodenum was noted and overlies and envelops the pancreas. The mass obstructed the common bile duct at the duodenal papilla.
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Liver – cholangio-hepatitis complex, neoplasia, lipidosis, abscessation, granulomatous disease
Gall bladder obstruction – lith, neoplasia, duodenal/pancreatic disease
Pancreas – neoplasia, pancreatitis
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