ABSTRACT
BACKGROUND/AIMS: Differentially diagnosing focal-type autoimmune pancreatitis (f-AIP) and pancreatic cancer (PC) is challenging. Contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) may provide information for differentiating pancreatic masses. In this study, we evaluated the usefulness of CEH-EUS in differentiating f-AIP from PC. METHODS: Data were collected prospectively and analyzed on patients who underwent CEH-EUS between May 2014 and May 2015. Eighty consecutive patients were diagnosed with f-AIP or PC. PC and f-AIP were compared for enhancement intensity, contrast agent distribution, and internal vasculature. RESULTS: The study group comprised 53 PC patients and 27 f-AIP patients (17 with type-1 AIP [15 definite and two probable], two with probable type-2 AIP, and eight with AIP, not otherwise specified). Hyper- to iso-enhancement in the arterial phase (f-AIP, 89% vs PC, 13%; p < 0.05), homogeneous contrast agent distribution (f-AIP, 81% vs PC, 17%; p < 0.05), and absent irregular internal vessels (f-AIP, 85% vs PC, 30%; p < 0.05) were observed more frequently in the f-AIP group. The combination of CEH-EUS and enhancement intensity, absent irregular internal vessels improved the specificity (94%) in differentiating f-AIP from PC. CONCLUSIONS: CEH-EUS may be a useful noninvasive modality for differentially diagnosing f-AIP and PC. Combined CEH-EUS findings could improve the specificity of CEH-EUS in differentiating f-AIP from PC.
Subject(s)
Humans , Biopsy, Fine-Needle , Contrast Media , Endosonography , Pancreatic Neoplasms , Pancreatitis , Prospective Studies , Sensitivity and Specificity , UltrasonographyABSTRACT
Adult-onset Still's Disease (AOSD) is a rare, immune-mediated, multisystem inflammatory disorder characterized by quotidian spiking fevers, an evanescent rash, arthritis, lymphadenopathy, splenomegaly, a sore throat, leukocytosis, and liver dysfunction. Its clinical manifestations are very diverse, from relatively mild symptoms to severe complications, such as disseminated intravascular coagulation, cardiac tamponade, acute respiratory distress syndrome, hemophagocytic syndrome, and hepatic failure. Hepatic failure is an extremely rare complication that could lead to death. Therefore, early diagnosis and treatment are important. We report a case of adult-onset Still's disease with acute febrile hepatitis.
Subject(s)
Adult , Humans , Arthritis , Cardiac Tamponade , Disseminated Intravascular Coagulation , Early Diagnosis , Exanthema , Fever , Hepatitis , Leukocytosis , Liver Diseases , Liver Failure , Lymphatic Diseases , Lymphohistiocytosis, Hemophagocytic , Pharyngitis , Respiratory Distress Syndrome , Splenomegaly , Still's Disease, Adult-OnsetABSTRACT
Sarcoidosis is a multisystemic granulomatous disorder that commonly involves the lungs, skin, and eyes. The coexistence of sarcoidosis with a kidney disorder and pulmonary hemorrhage is extremely rare. Hypercalciuria and hypercalcemia are the most common manifestations of renal involvement, although granulomatous interstitial nephritis, glomerular disease, and obstructive uropathy also occur in sarcoidosis. Acute tubular necrosis associated with acute renal failure generally shows early remission. In Korea, no cases of sarcoidosis associated with acute tubular necrosis and pulmonary hemorrhage have been reported. Here, we describe the case of a 65-year-old man with stage 3 sarcoidosis associated with acute tubular necrosis and pulmonary hemorrhage. The patient was treated with steroid and hydroxychloroquine for approximately 1 month. Most of his symptoms improved gradually, and he has been symptom-free since then.