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- W4220787126 abstract "A 37-year-old man with liver cirrhosis and chronic pancreatitis presented to the emergency department with a 4-day history of dull left upper-quadrant abdominal pain accompanied by fever and chills. Three weeks previously, he had undergone endoscopic retrograde cholangiopancreatography and drainage for obstructive pancreatitis. On examination, his blood pressure was 127/87 mm Hg, pulse rate was 147 beats/min, and temperature was 39.1 °C. He experienced tenderness over the epigastrium and left upper quadrant. Laboratory testing was only noteworthy for a serum C-reactive protein level of 25 mg/dL and a normal white cell count and serum lipase level. The physician performed abdominal point-of-care ultrasonography (Figures 1 and 2 and Video 1), and the diagnosis was confirmed using contrast-enhanced computed tomography (Figure 2).Figure 2Similar view in computed tomography showed air fluid level within a pseudocyst (arrowhead), which confirmed the presence of infected pancreatic pseudocysts. The spleen and aorta are marked with an asterisk and an arrow, respectively.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Infected pancreatic pseudocyst. The patient was treated with antibiotics and image-guided percutaneous drainage, which demonstrated the presence of Escherichia coli. He was discharged uneventfully 8 days later. At 1 month of follow-up, physicians removed the drainage tube, and at 3 months, he was asymptomatic. Infected pancreatic pseudocyst is rare but associated with high morbidity. Ultrasonography often demonstrates debris within the cyst and, sometimes, gas bubbles, although a diagnosis cannot be made based on imaging alone.1Cantasdemir M. Kara B. Kantarci F. et al.Percutaneous drainage for treatment of infected pancreatic pseudocysts.South Med J. 2003; 96: 136-140Google Scholar,2Kim Y.H. Saini S. Sahani D. et al.Imaging diagnosis of cystic pancreatic lesions: pseudocyst versus nonpseudocyst.RadioGraphics. 2005; 25: 671-685Google Scholar Management involves intravenous antibiotic administration and either percutaneous or open drainage.3Tan J.H. Chin W. Shaikh A.L. et al.Pancreatic pseudocyst: dilemma of its recent management (review).Exp Ther Med. 2021; 21: 159Google Scholar https://www.annemergmed.com/cms/asset/bf8df381-fb49-4a23-a69e-3f4c5e818e52/mmc1.mp4Loading ... Download .mp4 (3.75 MB) Help with .mp4 files Video 1Point-of-care ultrasound demonstrated pancreatic pseudocysts with irregular margins, debris, and gas formation in the pancreatic tail (arrowhead)." @default.
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- W4220787126 date "2022-04-01" @default.
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- W4220787126 title "Man with Left Upper Quadrant Pain" @default.
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- W4220787126 doi "https://doi.org/10.1016/j.annemergmed.2021.10.010" @default.
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