Pancreatic Lesion: Malignancy or Abscess?

• DOI: 10.12659/ajcr.895621
• Publication Date: 2016-05-18T06:23:15Z
• Authors: Oleg Shulik; Yana Cavanagh; Matthew Grossman
• Keywords: Chills; Pancreatic abscess; Head of pancreas

BACKGROUND:Pancreatic abscesses are rare. They may be seen in patients with pancreatic inflammation or pancreatitis. Patients have abdominal pain, fever, chills, and nausea/vomiting an inability to eat. Presentation alternate symptomatology is extremely unusual. CASE REPORT:A 67-year-old Asian male presented painless, afebrile obstructive jaundice a CA 19-9 of 1732 IU. He was found 3.1×2.4 cm low-density lesion the head pancreas right lobe liver, suggesting malignancy. Surgical management considered, however additional diagnostic workup, including endoscopic retrograde cholangiopancreatography (ERCP), performed complete staging presumed mass. A smooth, 3-cm-long, tapering stricture it common bile duct. It stented from hepatic duct duodenum. Subsequent ultrasound (EUS) evaluation revealed drainable fluid collection that aspirated contain pyogenic material on pathology. The patient’s symptoms resolved, he subsequently managed conservatively. repeat ERCP confirmed resolution previously visualized cystic lesion. Interestingly, laboratory values showed concomitant normalization 40 CONCLUSIONS:EUS-guided biopsy not widely regarded as required step before surgery, masses. generally reserved for determination resectability staging, only utilized when clinically indicated. However, this practice associated inherently significant risk misdiagnosis subsequent unnecessary illustrated by case. Malignancy initially suspected our patient surgical resection recommended. Endoscopic measures were pursued staging. We propose EUS-guided crucial algorithm lesions selected patients. In addition, we encourage consideration nonmalignant collections differential diagnosis masses, especially present diabetes mellitus.