Man 31 yo, one week ago complained of epigastric pain and vomiting.
Clinical examination he had red skin on the right thorax and atrophied
muscles of right arm.
Emergent abdominal ultrasound scan showed one mass of 4cm located near the head of
pancreas, at processus uncinatus which compressed
duodenum..
(see 3 ultrasound pictures.. P1.color doppler at right subclavicule suspected A-V-M) , P4 .P5..crossed scan and longitudinal scan of this mass at the head of pancreas.)
(see 3 ultrasound pictures.. P1.color doppler at right subclavicule suspected A-V-M) , P4 .P5..crossed scan and longitudinal scan of this mass at the head of pancreas.)
Gastroendoscopy went down just to duodenum but nothing detected.
MSCT with CE: this mass was in retroperitoneum compressing duodenum
D2,
contrast injection was slowly enhancement , but it had air in the mass ( see 4 CT with CE pictures CT1, is angiogram of right
axillary artery, CT2. this mass with air inside, CT3, relation with right
kidney and aorta, CT4 vascular SMA and mass).
Blood tests were no abnormal.
What is your suggestion for diagnosis ?.
Operation laparotomy for biopsy this tumor and bypass anatomosis ; this tumor was covered SMA then cannot remove.
Microscopy is fibrosis, no cancer cell detection.
Operation laparotomy for biopsy this tumor and bypass anatomosis ; this tumor was covered SMA then cannot remove.
Microscopy is fibrosis, no cancer cell detection.
It is a fibrosis mesenteric case.
Discussion: this 31 yo patient, vomitting at the clinical onset,
due to
obstruction of upper GI tract .
Ultrasound and CT showed the mass
near the processus uncinatus
of pancreas and SMA
encasement .
Operation cannot
remove this tumor because
it fixed to superior
mesenteric artery, biopsy this
mass with report no cancer cell,only fibrosis
tissue suggesting a pseudotumor like mesenteric
panniculatis. It is rare
case response with corticoid
treatment or with
colchicine.
REFERENCE
case of mesenteric panniculatis.
