Barron, 17y MN DSH, is here for an ultrasound today to evaluate a cranial abdominal mass seen on radiographs.  Barron has not been eating well for last couple of weeks.  Had a dentistry last week in hopes oral disease may contributing to the anorexia, but anorexia persists.  Mirtazipine was started yesterday and he did eat this am.  Blood work was unremarkable – mild inc. in BUN, high normal T4, normal coags.  

Barron, 17y MN DSH, is here for an ultrasound today to evaluate a cranial abdominal mass seen on radiographs.  Barron has not been eating well for last couple of weeks.  Had a dentistry last week in hopes oral disease may contributing to the anorexia, but anorexia persists.  Mirtazipine was started yesterday and he did eat this am.  Blood work was unremarkable – mild inc. in BUN, high normal T4, normal coags.  
Brief exam today revealed a systolic heart murmur.  No arrythmia ausculted and lungs are clear. Weight 4.34 kg, Temp 100.7, HR 184, mm – pink, CRT 1. 

The pancreas is very abnormal on ultrasound with hyperechoic and mottled parenchyma and cystic mass effect dorsally measuring up to 4.4 x 2.6 cm.  The portal vein appears to be going through the cystic region.  The dorsal stomach wall is in close proximity, but does not appear to be attached to the cystic appearing mass. 

There is a hyperechoic liver nodule in the left lobe w/ a cystic region more dorsal and vasculature present within the nodule and the edge of the cystic region.   

Performed FNA of the liver today.  Pending results, will plan to use heavier sedation and perform drainage of cystic structures, followed by fluid analysis and cytology.  Opted this route as concern about vasculature coursing through the cystic region and will want to keep him hospitalized for most of the day following the drainage to monitor for any complications. 

My rule outs include infiltrative disease vs. pancreatitis/pancreatic abscess vs. benign cysts