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Special Feature
March 2011

Image of the Month—Quiz Case

Author Affiliations

Author Affiliations: Departments of Otolaryngology[[ndash]]Head and Neck Surgery (Dr Loyo) and Surgery (Drs Guzzo, Lum, and Freischlag), The Johns Hopkins University, Baltimore, Maryland.



Arch Surg. 2011;146(3):365. doi:10.1001/archsurg.2011.15-a

A 65-year-old man with a long-standing history of repeated admissions for treatment of recurrent alcoholic pancreatitis presented to the emergency department with increasing epigastric pain after a night of binge alcohol drinking. The patient's history revealed 1 day of mild nausea and sharp upper abdominal pain that radiated through to the back. The patient was afebrile with no hemodynamic instability but had prominent epigastric abdominal tenderness. Laboratory evaluation results showed normal renal and hepatic chemical factors, a lipase level of 1248 U/L, and a drop in the hemoglobin level of 3 g/dL in the past 5 months (to convert lipase to microkatals per liter, multiply by 0.0167; to convert hemoglobin to grams per liter, multiply by 10).

In the emergency department, computed tomography (CT) of the abdomen was performed after intravenous administration of contrast medium (Figure 1). This study demonstrated peripancreatic inflammation compatible with chronic pancreatitis and a new 3.7 × 2.9-cm contrast-enhancing collection near the tail of the pancreas.

Figure 1. 
Computed tomography of the abdomen and pelvis.

Computed tomography of the abdomen and pelvis.

What Is the Diagnosis?

A.  Pancreatic pseudocyst

B.  Splenic artery pseudoaneurysm

C.  Arteriovenous malformation

D.  Pancreaticoduodenal artery aneurysm