Presentation
Presented with epigastric pain and cholestatic jaundice since 2 months; vomiting and fever since 3 days
Patient Data
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CECT abdomen and pelvis revealed chronic calcific pancreatitis.
Intrahepatic biliary radicle dilatation and dilated common bile duct upto the level of head of pancreas noted – likely due to stricture of distal common bile duct.
ERCP + CBD stenting was performed.
Later on, after 3 months, he presented with severe epigastric pain. Hence, cholangitis or stent block was suspected for the patient.
CT abdomen and pelvis with contrast (second study)
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CECT abdomen and pelvis revealed –
Differential attenuation of liver noted. Multiple subcentimetric hypodense areas noted in both lobes. Mild intrahepatic biliary radicle dilatation noted. Subscapular collection noted along segments VI and VII of liver. Filling defects noted in main portal and splenic veins - suggestive of thrombosis.
Pericholecystic thickening/fluid noted. Common bile duct stent insitu.
Features of chronic calcific panreatitis noted. Ill defined small hypodense lesion noted in the head of pancreas, showing peripheral enhancement.
Multiple preaortic, peripancreatic, mesenteric, left para-aortic and aortocaval lymph nodes noted, few of these showing necrosis.
Minimal ascites.
The lesions in the liver were given a differential diagnosis of abscesses or metastases.
Case Discussion
Ascitic tapping was performed for the patient. Cytology for the body fluid was suspicious for atypia or malignancy. Further on, Ultrasound guided biopsy was performed for the liver lesion, which gave a diagnosis of metastatic adenocarcinoma liver.