Patient presents with worsening chronic diarrhea for two years and cramping abdominal pain. Patient denies any travel, antibiotic usage, dietary modifications, or sick contacts. Previous medication regimen comprised of Lomotil and Imodium were ineffective.
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CT of the abdomen and pelvis without contrast was significant for multiple ill-defined, hypodense liver lesions. There was also a hypodense, cystic lesion in the tail of the pancreas measuring 1.0 cm.
On arterial phase imaging, again seen are multiple, non-specific, hypodense liver lesions. The lesion in the tail of the pancreas shows subtle peripheral enhancement.
Venous phase imaging again demonstrates the hypodense lesion in the pancreatic tail, now with peripheral enhancement.
Initial workup was negative for viral, bacterial, parasitic, inflammatory, osmotic, and malabsorptive etiologies of diarrhea. Patient’s laboratory workup was significant for electrolyte disturbances including hypokalemia, hyponatremia (K 2.6, Na 127) and Vasoactive Intestinal Peptide (VIP) of 1930 (normal 0-60).
The patient underwent an ultrasound guided liver biopsy of a liver lesion seen on CT. Pathology results from patient's liver biopsy showed metastatic neuroendocrine cells in the liver representing a tumor arising from the endocrine pancreas (VIPoma).
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