Our Imaging Case of the Month is presented as a part of the Imaging Department's residency teaching program. Each month a resident collaborates with one of our attending imaging physicians to present an interesting case to the Cedars-Sinai medical community. The case is used to teach both imaging and other residents at Cedars-Sinai. Below is the current Case of the Month.
Submitted by Stephen Chan, MD and Thomas Learch, MD.
History of Present Illness
49-year-old female presents with aching epigastric pain that radiates to the left upper quadrant for the past week. She was diagnosed with gastritis 1 month ago and started on omeprazole. She has also had nausea with 3-4 episodes of nonbloody nonbilious emesis in the past week. Denies hematemesis.
Past Medical History
Hospitalized for acute pancreatitis 17 years ago, denies any other episodes Gastritis diagnosed 1 month ago
Past Surgical History
- Lives with son and husband. Not employed.
- Tobacco: ⅓ pack per day for the last 35 years
- Alcohol: 1 pint hard liquor per day for the last 10 years
- Other: Denies other substances
Omeprazole 10mg oral per day
Review of Systems
Positive for abdominal pain, nausea, and vomiting. Otherwise negative.
- Pulse: 98 bpm
- Respiratory Rate: 18
- Blood Pressure: 124/82
- Temperature: 98.5 F
- Oxygen Saturation: 99%
- Well appearing female in no acute distress, with mild epigastric/left upper quadrant tenderness.
- No rebound or guarding.
CBC and CMP within normal limits.
Abdominal ultrasound was ordered:
Ultrasound showed large complex cystic masses adjacent to the left kidney and liver. Abdominal CT was performed for further evaluation.
CT showed pancreatic calcifications and a large fluid collection inseparable from the pancreas, liver, stomach, and left kidney- likely a pancreatic pseudocyst.
Endoscopic ultrasound was performed. A pseudocyst was identified with a 45mm x 30 mm portion adjacent to the pancreas, which was drained uneventfully via cystogastrostomy. Other findings included pancreatic calcifications consistent with moderate-severe chronic pancreatitis as well as mild gastritis.