Case of the Month 2016-07

Epigastric Pain

Submitted by Catherine Evans, MD, and Thomas J. Learch, MD.

A 55 year-old female with no significant past medical history presents to the emergency department with complaint of diffuse, sharp and intermittent epigastric pain for 1 month. The pain worsens post-prandially. Review of systems is significant for increased appetite and weight gain over the same period. She also notes constipation over the last week. Physical exam demonstrates normoactive bowel sounds and a soft, nondistended abdomen. There is moderate epigastric and suprapubic tenderness to palpation. No masses or hepatosplenomegaly are appreciated.Labs reveal mild hypercalcemia. All other biomarkers are negative.

What is the positive finding in the CT below?

For larger images, please click on Epigastric 1 , Epigastric 2 and Epigastric 3 .

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