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Mucinous cystic neoplasm

Knaus CMK - MedPix (2013)

View Article: MedPix Image - MedPix Case

Affiliation: Walter Reed National Military Medical Center

ABSTRACT

Diagnosis: Mucinous cystic neoplasm

History: This 36 yo woman presents to the ED with severe upper back pain, nausea, four episodes of bilious vomiting, fevers, chills, and headaches. The pain, which woke her from sleep, includes the majority of her back, left more than right, from the mid-scapulae to the middle of her back. She denied any SOB or dizziness. She endorsed having regular bowel movements and urination and that her LMP was one week ago. Denies being pregnant and said she had two recent pregnancy tests, which were negative. PMHx: h/o gallstone pancreatitis in 2006 PSHx: cholecystectomy 2006 Breast reduction

Findings: 1. Large complex cystic lesion in the left upper quadrant which appears to arise from the pancreas and has an appearance of a mucinous cystic tumor with differential considerations given to solid and papillary neoplasm and cystic metastatic disease. 2. Separate, nonenhancing cystic lesion in the posterior mediastinum at the level of the esophageal hiatus which may represent an enteric duplication cyst versus metastatic focus. 3. Gastric varices/portosystemic collateral vessels, mild central intrahepatic biliary ductal dilatation and delayed left nephrogram likely secondary to mass effect from dominant mass in the abdomen.

Ddx: - Mucinous cystic tumor - Solid and papillary neoplasm - Cystic metastatic disease

Dxhow: Pathology of biopsy during urgent laproscopy

Exam: Vitals - HR 91-128, BP 109/68, T 97.8-99.4, Tc 98.4, RR 14-21, SaO2 97%ra. Gen - NAD, pleasant, cooperative HEENT - PERRL, EOMI, no scleral icterus. CV - tachycardic, nml S1/S2, 2/6 systolic flow murmur. Lungs - CTA B/L, no wheezes/crackles Abdo - Diminished bowel sounds, soft with large LUQ mass - firm, smooth, occupying entire LUQ and encroaching on RUQ, nontender Extr - no LE edema, 2+ pulses x4

No MeSH data available.


There is persistence of abnormal, diffuse irregular gaseous pockets which are similar to prior abdominal film however new compared to acute abdominal series from prior day that are suspicious for free intraperitoneal air. Air and contrast are again demonstrated throughout the large bowel.  There is the appearance of two gastric bubbles overlying the left upper quadrant which could represent mass compression of the stomach or free air under the diaphragm.  Large abdominal soft tissue mass is not significantly changed compared to priors. There also appears to be air overlying the peripheral aspect of the mass. Redemonstrated are cholecystectomy clips over right upper quadrant and single surgical clip overlying left pelvis.  No abnormal calcifications.  The soft tissues and osseous structures are not significantly changed and grossly unremarkable.
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MPX2411_synpic58712: There is persistence of abnormal, diffuse irregular gaseous pockets which are similar to prior abdominal film however new compared to acute abdominal series from prior day that are suspicious for free intraperitoneal air. Air and contrast are again demonstrated throughout the large bowel. There is the appearance of two gastric bubbles overlying the left upper quadrant which could represent mass compression of the stomach or free air under the diaphragm. Large abdominal soft tissue mass is not significantly changed compared to priors. There also appears to be air overlying the peripheral aspect of the mass. Redemonstrated are cholecystectomy clips over right upper quadrant and single surgical clip overlying left pelvis. No abnormal calcifications. The soft tissues and osseous structures are not significantly changed and grossly unremarkable.


Mucinous cystic neoplasm

Knaus CMK - MedPix (2013)

There is persistence of abnormal, diffuse irregular gaseous pockets which are similar to prior abdominal film however new compared to acute abdominal series from prior day that are suspicious for free intraperitoneal air. Air and contrast are again demonstrated throughout the large bowel.  There is the appearance of two gastric bubbles overlying the left upper quadrant which could represent mass compression of the stomach or free air under the diaphragm.  Large abdominal soft tissue mass is not significantly changed compared to priors. There also appears to be air overlying the peripheral aspect of the mass. Redemonstrated are cholecystectomy clips over right upper quadrant and single surgical clip overlying left pelvis.  No abnormal calcifications.  The soft tissues and osseous structures are not significantly changed and grossly unremarkable.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX2411&req=5

MPX2411_synpic58712: There is persistence of abnormal, diffuse irregular gaseous pockets which are similar to prior abdominal film however new compared to acute abdominal series from prior day that are suspicious for free intraperitoneal air. Air and contrast are again demonstrated throughout the large bowel. There is the appearance of two gastric bubbles overlying the left upper quadrant which could represent mass compression of the stomach or free air under the diaphragm. Large abdominal soft tissue mass is not significantly changed compared to priors. There also appears to be air overlying the peripheral aspect of the mass. Redemonstrated are cholecystectomy clips over right upper quadrant and single surgical clip overlying left pelvis. No abnormal calcifications. The soft tissues and osseous structures are not significantly changed and grossly unremarkable.

View Article: MedPix Image - MedPix Case

Affiliation: Walter Reed National Military Medical Center

ABSTRACT

Diagnosis: Mucinous cystic neoplasm

History: This 36 yo woman presents to the ED with severe upper back pain, nausea, four episodes of bilious vomiting, fevers, chills, and headaches. The pain, which woke her from sleep, includes the majority of her back, left more than right, from the mid-scapulae to the middle of her back. She denied any SOB or dizziness. She endorsed having regular bowel movements and urination and that her LMP was one week ago. Denies being pregnant and said she had two recent pregnancy tests, which were negative. PMHx: h/o gallstone pancreatitis in 2006 PSHx: cholecystectomy 2006 Breast reduction

Findings: 1. Large complex cystic lesion in the left upper quadrant which appears to arise from the pancreas and has an appearance of a mucinous cystic tumor with differential considerations given to solid and papillary neoplasm and cystic metastatic disease. 2. Separate, nonenhancing cystic lesion in the posterior mediastinum at the level of the esophageal hiatus which may represent an enteric duplication cyst versus metastatic focus. 3. Gastric varices/portosystemic collateral vessels, mild central intrahepatic biliary ductal dilatation and delayed left nephrogram likely secondary to mass effect from dominant mass in the abdomen.

Ddx: - Mucinous cystic tumor - Solid and papillary neoplasm - Cystic metastatic disease

Dxhow: Pathology of biopsy during urgent laproscopy

Exam: Vitals - HR 91-128, BP 109/68, T 97.8-99.4, Tc 98.4, RR 14-21, SaO2 97%ra. Gen - NAD, pleasant, cooperative HEENT - PERRL, EOMI, no scleral icterus. CV - tachycardic, nml S1/S2, 2/6 systolic flow murmur. Lungs - CTA B/L, no wheezes/crackles Abdo - Diminished bowel sounds, soft with large LUQ mass - firm, smooth, occupying entire LUQ and encroaching on RUQ, nontender Extr - no LE edema, 2+ pulses x4

No MeSH data available.