– 7 year old MN DSH presented for jaundice and anroexia
– liver diffusely hyperechoic (isoechoic to the spleen) ddx: hepatitis, hepatic lipidosis, lymphoma (least likely)
– no lesions at the d-pap and GB and CBD normal at 0.28 cm diameter
– the pancreas has a very heterogenous appearance and is midly enlarged; hyperechoic peripancreatic fat is not appreciated
– duodeum mily thickened and corrugated
– pancreatic enzymes are normal; ALP and ALT moderately elevated and bilirubin severely elevated – no anemia
– 7 year old MN DSH presented for jaundice and anroexia
– liver diffusely hyperechoic (isoechoic to the spleen) ddx: hepatitis, hepatic lipidosis, lymphoma (least likely)
– no lesions at the d-pap and GB and CBD normal at 0.28 cm diameter
– the pancreas has a very heterogenous appearance and is midly enlarged; hyperechoic peripancreatic fat is not appreciated
– duodeum mily thickened and corrugated
– pancreatic enzymes are normal; ALP and ALT moderately elevated and bilirubin severely elevated – no anemia
Despite normal PSL, I do believe that this patient has significant pancreatic disease. Is it a chronic pancreatitis presenatation, acute on chronic? scarring from previous pancreatitis? edema?
There is a trace effusion in this abdomen. Jejunal LN’s normal.
Comments
I agree that the pancreas
I agree that the pancreas looks ugly but would also still be suspicious of hepatic lymphoma or cholangiohepatitis based upon the hyperbilirubinemia and lack of any overt extrahepatic biliary obstruction (and I assume no IMHA). Did you FNA or biopsy the liver and or pancreas?
This pancreas is suely lumped
This pancreas is suely lumped up and has had insults and may have low grade chronic inflammation so it needs a needle especially int he hypoechoic region in your last video. Check for pain on imaging (+Murphy sign). There isnt any inflamed peripancreatice fat that I can see though so tough to say if pancreatitis is active or past event… hence the needle… 25 gauge should do it and sounds like liver needs one too. Smoldering pancreatitis with secondary lipidosis is more common with this history and scenario than lsa but lsa can live in lipidosis too… again… the reason we have needles:)
Thanks guys – pure money case
Thanks guys – pure money case here so will go forward with trying to treat the treatable. Hopefully we will be able to place a PEG tube.